Provider Demographics
NPI:1801938873
Name:PRICE, SHERYL A (DO)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:A
Last Name:PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:A
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:STE C-136
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:623-776-2772
Mailing Address - Fax:623-776-2666
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:STE C-136
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-776-2772
Practice Address - Fax:623-776-2666
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200121040AMedicaid
AZ490115Medicaid
AZ490115Medicaid
245735202Medicare PIN