Healthcare Provider Details

I. General information

NPI: 1053603704
Provider Name (Legal Business Name): TERISA CHANTELE SAHLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERISA CHANTELE STOVER PA-C

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

IV. Provider business mailing address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-7925
  • Fax:
Mailing address:
  • Phone: 530-722-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21540
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: