Provider Demographics
NPI:1982710240
Name:ANDERSEN, SONDRA SUZETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:SUZETTE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-512-4176
Practice Address - Fax:623-512-4199
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ922733Medicaid
AZQ38819Medicare UPIN
AZ922733Medicaid