Provider Demographics
NPI:1295438240
Name:AGHAKHANIAN, SHERRY (FNP-C)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:AGHAKHANIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1270
Mailing Address - Country:US
Mailing Address - Phone:818-632-7743
Mailing Address - Fax:
Practice Address - Street 1:1141 N BRAND BLVD STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2583
Practice Address - Country:US
Practice Address - Phone:818-247-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35015829363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner