Provider Demographics
NPI:1083921472
Name:SHORDON, TARSY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TARSY
Middle Name:
Last Name:SHORDON
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 1:2015 BIRCH RD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2002
Mailing Address - Country:US
Mailing Address - Phone:619-216-0842
Mailing Address - Fax:
Practice Address - Street 1:2015 BIRCH RD
Practice Address - Street 2:SUITE 509
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2002
Practice Address - Country:US
Practice Address - Phone:619-216-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant