Provider Demographics
NPI:1104086487
Name:WOLF, SANDRA MARIA (PA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIA
Last Name:WOLF
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16387 W CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-6026
Mailing Address - Country:US
Mailing Address - Phone:623-251-5052
Mailing Address - Fax:
Practice Address - Street 1:3501 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-4037
Practice Address - Country:US
Practice Address - Phone:602-272-7676
Practice Address - Fax:602-272-1883
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005485363AM0700X
AZ6748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical