Shane Joseph Ewalt, Physician Assistant
Physician Assistant in Chandler, AZ. Individual provider (NPI-1).
NPI number1679091920
StatusActive
Last updated in NPPESJul 29, 2022
Details
- NPI
- 1679091920
- Entity type
- Individual (NPI-1)
- Name
- Shane Joseph Ewalt
- Credential
- Physician Assistant
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 7, 2017
- Certification date
- Jul 29, 2022
- Last updated
- Jul 29, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 6865 | AZ | Yes |
| 363AS0400X | Physician Assistant, Surgical | 6865 | AZ |
Practice location
525 S Chandler Village DrChandler, AZ 85226-5069
Phone 480-750-0303 · Fax 480-786-5202
Mailing address
Po Box 80217Phoenix, AZ 85060-0217
Phone 602-385-2115
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All 152 Physician Assistant providers in Chandler · All 7,680 providers in Chandler
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