Healthcare Provider Details

I. General information

NPI: 1104074533
Provider Name (Legal Business Name): SEAN GARLAND CHERRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MAIN ST
ELMA WA
98541-9560
US

IV. Provider business mailing address

305 EAST CENTER AVE/
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 360-346-2222
  • Fax: 360-346-2191
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-737-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19877
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19877
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.61098767
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: