MEDICARE: DEBBIE SUNSHINE MASCOVICH PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	763	CO
2	363A00000X	Physician Assistant	5137	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912983008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE SUNSHINE MASCOVICH PAC

Provider Business Mailing Address
First Line	:	PO BOX 47328
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85068-7328
Country	:	US
Telephone Number	:	970-778-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 N 19TH AVE STE 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2901
Country	:	US
Telephone Number	:	602-433-1822
Fax Number	:	602-246-7060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	11/28/2012

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Directions to “ DEBBIE SUNSHINE MASCOVICH PAC” Practice Location

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