Provider Demographics
NPI:1508065764
Name:SIERRA, ELVIS R (PA)
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:R
Last Name:SIERRA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8005 CREIGHTON PKWY
Mailing Address - Street 2:SUITE C, #132
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4594
Mailing Address - Country:US
Mailing Address - Phone:804-522-1501
Mailing Address - Fax:804-522-1502
Practice Address - Street 1:6501 MECHANICSVILLE TPKE STE G1
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3698
Practice Address - Country:US
Practice Address - Phone:804-522-1501
Practice Address - Fax:804-522-1502
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
VA0110002708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical