Provider Demographics
NPI:1366532145
Name:MAYO, SHEILA COMPTON (PA-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:COMPTON
Last Name:MAYO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SHEILA
Other - Middle Name:LORRAINE
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:2335 E KASHIAN LN STE 410
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2234
Practice Address - Country:US
Practice Address - Phone:559-266-4100
Practice Address - Fax:559-266-4199
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23273363A00000X, 363AM0700X
GA004063363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP91555Medicare UPIN