Individual
SHEA PERILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
6553 E BAYWOOD AVE, MESA, AZ 85206-1752
(480) 969-3532
Mailing address
6553 E BAYWOOD AVE, STE 101B, MESA, AZ 85206-1752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4507
AZ
363AS0400X
Surgical Physician Assistant
4507
AZ
Other
Enumeration date
09/21/2009
Last updated
04/04/2014
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