Provider Demographics
NPI:1407144843
Name:SWEENEY, PAUL (DOM AP LIC AC CMH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DOM AP LIC AC CMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0308
Mailing Address - Country:US
Mailing Address - Phone:480-650-1047
Mailing Address - Fax:
Practice Address - Street 1:6064 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1802
Practice Address - Country:US
Practice Address - Phone:602-279-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist