Provider Demographics
NPI:1316167943
Name:PETERSON, SHERYL L (CPNP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S DOBSON RD
Mailing Address - Street 2:BLDG 2145 SUITE 258
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4707
Mailing Address - Country:US
Mailing Address - Phone:480-412-6344
Mailing Address - Fax:480-412-6443
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:BLDG 2145 SUITE 258
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-412-6344
Practice Address - Fax:480-412-6443
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics