Healthcare Provider Details

I. General information

NPI: 1548331341
Provider Name (Legal Business Name): SHERI W AGRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHERI LY-LEN WOO

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

FILE 56765
LOS ANGELES CA
90074-6765
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3430
  • Fax: 602-406-4058
Mailing address:
  • Phone: 602-406-3860
  • Fax: 602-406-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: