Provider Demographics
NPI:1083306369
Name:SHUGHROU, SEAN CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:SHUGHROU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40233 ODESSA DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6167
Mailing Address - Country:US
Mailing Address - Phone:951-283-7151
Mailing Address - Fax:
Practice Address - Street 1:40233 ODESSA DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6167
Practice Address - Country:US
Practice Address - Phone:951-283-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical