Provider Demographics
NPI:1053443804
Name:SHEESLEY, CHAD (PA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:SHEESLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 29TH ST
Mailing Address - Street 2:450
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5125
Mailing Address - Country:US
Mailing Address - Phone:916-733-5066
Mailing Address - Fax:916-733-8705
Practice Address - Street 1:1020 29TH ST
Practice Address - Street 2:450
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5125
Practice Address - Country:US
Practice Address - Phone:916-733-5066
Practice Address - Fax:916-733-8705
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA172110Medicaid
CAQ17385Medicare UPIN
CA0PA172110Medicaid