Provider Demographics
NPI:1720133663
Name:SHERWOOD, SCOTT BRADY (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BRADY
Last Name:SHERWOOD
Suffix:
Gender:M
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 1:2964 E PONY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8775
Mailing Address - Country:US
Mailing Address - Phone:480-988-9568
Mailing Address - Fax:
Practice Address - Street 1:3048 E BASELINE RD STE 113
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7287
Practice Address - Country:US
Practice Address - Phone:480-497-9414
Practice Address - Fax:480-497-8430
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant