Provider Demographics
NPI:1164538948
Name:FAHEY, SHARI ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:FAHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 312
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-832-0076
Practice Address - Fax:952-832-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
112424OtherMEDICA
969991027685OtherPREFERREDONE
HP43531OtherHEALTHPARTNERS
73B57FAOtherBLUE CROSS BLUE SHIELD
969991027685OtherPREFERREDONE