Provider Demographics
NPI:1588784920
Name:GRONDON, SHERRI (PA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:GRONDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2627
Mailing Address - Country:US
Mailing Address - Phone:602-264-4431
Mailing Address - Fax:602-266-3870
Practice Address - Street 1:202 E EARLL DR
Practice Address - Street 2:SUITE 360
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2627
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-266-3870
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002821363A00000X
AZ5076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant