Individual
SHELDON GARTH LIECHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
19841 N 27TH AVE, SUITE 201, PHOENIX, AZ 85027-4003
(623) 582-6420
(623) 582-6720
Mailing address
19841 N 27TH AVE, SUITE 201, PHOENIX, AZ 85027-4003
(623) 582-6420
(623) 582-6720
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2625
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1050116
NCCPA
AZ
Enumeration date
03/20/2007
Last updated
03/02/2010
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