Provider Demographics
NPI:1669583340
Name:SINISCAL, JOHNNY WAYNE (PHYSICANS ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:WAYNE
Last Name:SINISCAL
Suffix:
Gender:M
Credentials:PHYSICANS ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:20770 SW SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10100 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-8278
Practice Address - Fax:503-571-2740
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OROR PA 00079363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical