Provider Demographics
NPI:1427232792
Name:PIELECHA, MATTHEW HENRY (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:HENRY
Last Name:PIELECHA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:95 SOLDIERS PASS RD
Mailing Address - Street 2:STE B
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4781
Mailing Address - Country:US
Mailing Address - Phone:928-774-2788
Mailing Address - Fax:928-774-0123
Practice Address - Street 1:1515 E CEDAR AVE STE A-3
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1630
Practice Address - Country:US
Practice Address - Phone:928-774-2788
Practice Address - Fax:928-774-0123
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2018-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3792363A00000X
NVPA1368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGN698ZMedicare PIN
NVGN698YMedicare PIN