Provider Demographics
NPI:1548331341
Name:AGRAN, SHERI W (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:W
Last Name:AGRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHERI
Other - Middle Name:LY-LEN
Other - Last Name:WOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:FILE 56765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6765
Mailing Address - Country:US
Mailing Address - Phone:602-406-3860
Mailing Address - Fax:602-406-6132
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3430
Practice Address - Fax:602-406-4058
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ843294Medicaid
Z112909Medicare PIN
AZZ123710Medicare PIN