Provider Demographics
NPI:1598951923
Name:SMITH, SHERI LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LEE
Last Name:SMITH
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 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7101
Mailing Address - Country:US
Mailing Address - Phone:714-848-7676
Mailing Address - Fax:714-848-7626
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 367
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-848-7676
Practice Address - Fax:714-848-7626
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant