Provider Demographics
NPI:1962701920
Name:WALSH SHERYKA, PEGGY DIANA (PA-C)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:DIANA
Last Name:WALSH SHERYKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:DIANA
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-493-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07177363AS0400X
COPA.0004293363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00942379OtherMEDICARE RAILROAD
TX282238901Medicaid
TXP00942379OtherMEDICARE RAILROAD