Provider Demographics
NPI:1013973205
Name:WATSON, SHELDON BURDELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:BURDELL
Last Name:WATSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:412 AMDS/SGPF
Mailing Address - Street 2:30 NIGHTINGALE RD
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93534-1730
Mailing Address - Country:US
Mailing Address - Phone:661-277-2575
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER/OKUBO CLINIC
Practice Address - Street 2:9040 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1730
Practice Address - Country:US
Practice Address - Phone:253-966-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1036622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical