Healthcare Provider Details

I. General information

NPI: 1104086487
Provider Name (Legal Business Name): SANDRA MARIA WOLF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W OSBORN RD
PHOENIX AZ
85019-4037
US

IV. Provider business mailing address

16387 W CANTERBURY DR
SURPRISE AZ
85388-6026
US

V. Phone/Fax

Practice location:
  • Phone: 602-272-7676
  • Fax: 602-272-1883
Mailing address:
  • Phone: 623-251-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6748
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: