Healthcare Provider Details

I. General information

NPI: 1134113723
Provider Name (Legal Business Name): SHARI E FREYER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

UNM COMPREHENSIVE CANCER CENTER 1 UNIVERSITY
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4946
  • Fax: 505-925-0100
Mailing address:
  • Phone: 505-272-4946
  • Fax: 505-925-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number97PA27
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: