Provider Demographics
NPI:1710924550
Name:SIKKELEE, SHARON CHAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:CHAN
Last Name:SIKKELEE
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 1:26000 HOOVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1167
Mailing Address - Country:US
Mailing Address - Phone:586-722-0707
Mailing Address - Fax:
Practice Address - Street 1:26000 HOOVER RD STE 105
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1167
Practice Address - Country:US
Practice Address - Phone:586-722-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35120007Medicare PIN