Healthcare Provider Details

I. General information

NPI: 1346971413
Provider Name (Legal Business Name): JORDAN SHERFEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 DOUGLAS ST
LONGVIEW WA
98632-2452
US

IV. Provider business mailing address

43575 MISSION BLVD STE 716
FREMONT CA
94539-5831
US

V. Phone/Fax

Practice location:
  • Phone: 360-940-0880
  • Fax: 844-697-8702
Mailing address:
  • Phone: 510-373-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61442498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: