Provider Demographics
NPI:1497925424
Name:CHACON, SHERI LOUISE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LOUISE
Last Name:CHACON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2617
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:888-316-1686
Practice Address - Street 1:11435 W BUCKEYE RD STE A106
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6812
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5623363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ889844Medicaid