Provider Demographics
NPI:1912942871
Name:HANDY, CHERYLL (PA C)
Entity Type:Individual
Prefix:MS
First Name:CHERYLL
Middle Name:
Last Name:HANDY
Suffix:
Gender:F
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:PO BOX 5299
Mailing Address - Street 2:MS: 737-2-PHYS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:253-459-7970
Mailing Address - Fax:
Practice Address - Street 1:505 S 336TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6328
Practice Address - Country:US
Practice Address - Phone:253-838-6180
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8452930Medicaid
WA0219013OtherLIWA
WA3455HAOtherBSWA
WAP32698Medicare UPIN
WA0219013OtherLIWA