SHANE JOSEPH EWALT (NPI# 1679091920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679091920 |
| Entity Type | Individual |
| Full Name | SHANE JOSEPH EWALT |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
525 S Chandler Village Dr Chandler AZ 85226-5069 |
| Mailing Address |
Po Box 80217 Phoenix AZ 85060-0217 |
| Practice Telephone | 4807500303 |
| Practice Fax Number | 4807865202 |
| Mailing Telephone | 6023852115 |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2020-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
525 S CHANDLER VILLAGE DR |
| City | CHANDLER |
| State | AZ |
| Zip Code | 85226-5069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104908276 | Christine M. Phillips | Physical Therapist | 525 S Chandler Village Dr, Chandler, AZ 85226-5152 | 2006-10-19 |
| 1134575350 | Orthopedic Specialists of North America Pllc | Orthopaedic Surgery | 525 S Chandler Village Dr, Suite 1, Chandler, AZ 85226-5152 | 2016-05-06 |
| 1720484942 | Jessica Gruca | Physical Therapist | 525 S Chandler Village Dr, Chandler, AZ 85226-5152 | 2014-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922594076 | Diplomat Specialty Pharmacy of Phoenix, LLC | Durable Medical Equipment & Medical Supplies | 485 N Juniper Dr, Chandler, AZ 85226 | 2018-07-02 |
| 1073011961 | Joshua David Heiller | Physical Therapist | 5590 W Chandler Blvd Ste B4, Chandler, AZ 85226 | 2018-01-25 |
| 1053771808 | Jessie Beliard | Counselor | 6909 W Ray Rd Ste 138, Chandler, AZ 85226 | 2016-03-07 |
| 1750754206 | Homestead Hospice of Phoenix LLC | Hospice Care, Community Based | 5355 W Chandler Blvd, Suite 3, Chandler, AZ 85226 | 2015-11-05 |
| 1003288192 | Savannah Torrez | Physical Therapist | 5590 W Chandler Blvd Ste B-4, Chandler, AZ 85226 | 2015-10-28 |
| 1437401528 | Larry W. Ganann | Pharmacist | 4949 W. Ray Road, Chandler, AZ 85226 | 2012-10-12 |
| 1629329503 | East Valley Urgent Care,llc | Clinic/Center | 4959 W Ray Road, Chandler, AZ 85226 | 2012-10-02 |
| 1457609158 | Patricia Dobratz | Marriage & Family Therapist | 6100 W Gila Springs Pl, Suite 19, Chandler, AZ 85226 | 2012-08-28 |
| 1831406388 | Chanda Lise Gonzales | Counselor | 6909 W Ray Rd Ste 15-143, Chandler, AZ 85226 | 2010-09-04 |
| 1689874323 | Arizona Dental Design | Dentist | 4940 W. Ray Road Suite 8, Chandler, AZ 85226 | 2007-07-20 |
| Find all providers in zip 85226 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528439965 | Amici Surgical Assistants | Physician Assistant | 123 W Chandler Heights Rd Unit 13132, Chandler, AZ 85248-1087 | 2015-10-12 |
| 1932527108 | John Proctor | Physician Assistant | 1210 W Shawnee Dr, Chandler, AZ 85224-2369 | 2014-04-03 |
| 1720237431 | Advanced Surgical Assistants LLC | Physician Assistant | 2074 E Honeysuckle Pl, Chandler, AZ 85286-2315 | 2008-09-17 |
| 1528013364 | Prime Surgical Assisting, LLC | Physician Assistant | 2905 W Warner Rd Ste 1, Chandler, AZ 85224-1674 | 2006-05-23 |
| 1356305890 | Christabelle N Wong | Physician Assistant | 975 E Riggs Rd, Suite 12-268, Chandler, AZ 85249-4260 | 2006-04-13 |
| 1629032206 | Delia Bautista Tobin | Physician Assistant | 1538 E Fairview St, Chandler, AZ 85225-2222 | 2006-04-12 |
| 1861491706 | Brian E Hertel | Physician Assistant | 4424 E Virgo Pl, Chandler, AZ 85249-5898 | 2005-07-21 |
| 1417435181 | Ellayna Wiedow | Physician Assistant | 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 | 2018-08-03 |
| 1922419191 | Advanced Surgical Physician Assistants, LLC | Physician Assistant | 2925 E Riggs Rd, Suite 8-114, Chandler, AZ 85249-3600 | 2014-05-09 |
| 1134465057 | Big Sky First Assists, LLC. | Physician Assistant | 333 N Dobson Rd, Ste.15, Chandler, AZ 85224-4412 | 2012-12-20 |
| Find all providers in CHANDLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.