Provider Demographics
NPI:1831529874
Name:CHICHESTER-SHEPPERD, SOHAAN A (PA)
Entity type:Individual
Prefix:
First Name:SOHAAN
Middle Name:A
Last Name:CHICHESTER-SHEPPERD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19185 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-7653
Mailing Address - Country:US
Mailing Address - Phone:863-448-9242
Mailing Address - Fax:863-491-0760
Practice Address - Street 1:1707 E OAK ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8925
Practice Address - Country:US
Practice Address - Phone:863-448-9242
Practice Address - Fax:863-491-0760
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107583363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ280ZMedicare PIN