Provider Demographics
NPI:1558055590
Name:QUEEN, SHERIDAN (PA)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHERIDAN
Other - Middle Name:K
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-821-2838
Mailing Address - Fax:
Practice Address - Street 1:1710 N 159TH AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7687
Practice Address - Country:US
Practice Address - Phone:623-312-3020
Practice Address - Fax:623-487-6747
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant