Provider Demographics
NPI:1336659507
Name:SHAUL, SHERA MIRIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERA
Middle Name:MIRIAM
Last Name:SHAUL
Suffix:
Gender:F
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 1:370 E VIRGINIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1254
Mailing Address - Country:US
Mailing Address - Phone:602-258-4788
Mailing Address - Fax:602-258-5131
Practice Address - Street 1:370 E VIRGINIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1254
Practice Address - Country:US
Practice Address - Phone:602-258-4788
Practice Address - Fax:602-258-5131
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6877363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical