Healthcare Provider Details

I. General information

NPI: 1538623269
Provider Name (Legal Business Name): SUSAN CLAIRE GUCCIARDI ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3158 N CLANTON ST
BUCKEYE AZ
85396-7707
US

IV. Provider business mailing address

3158 N CLANTON ST
BUCKEYE AZ
85396-7707
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-7375
  • Fax: 602-563-8218
Mailing address:
  • Phone: 602-603-7375
  • Fax: 602-563-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: