Provider Demographics
NPI:1730636689
Name:SHERBONDY, KATELYN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:SHERBONDY
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 1:17150 N 23RD ST UNIT 132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2276
Mailing Address - Country:US
Mailing Address - Phone:602-579-7822
Mailing Address - Fax:
Practice Address - Street 1:13075 W MCDOWELL RD STE D106
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6437
Practice Address - Country:US
Practice Address - Phone:602-579-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical