Healthcare Provider Details

I. General information

NPI: 1124011077
Provider Name (Legal Business Name): STERNS PEDIATRIC CLINIC,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 W GLENN DR SUITE #6
GLENDALE AZ
85301-2662
US

IV. Provider business mailing address

5406 W GLENN DR SUITE #6
GLENDALE AZ
85301-2662
US

V. Phone/Fax

Practice location:
  • Phone: 623-934-0245
  • Fax: 623-934-0428
Mailing address:
  • Phone: 623-934-0245
  • Fax: 623-934-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: SHIRLEY JEANETTE SHEINKOPF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-934-0245