Provider Demographics
NPI:1265640551
Name:BALLEHR, SANDRA LEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:LEE
Last Name:BALLEHR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3815 E BELL RD STE 2700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2155
Mailing Address - Country:US
Mailing Address - Phone:602-714-6970
Mailing Address - Fax:602-714-5176
Practice Address - Street 1:3815 E BELL RD STE 2700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2155
Practice Address - Country:US
Practice Address - Phone:602-714-6970
Practice Address - Fax:602-714-5176
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ618587Medicaid
AZ618587Medicaid