Provider Demographics
NPI:1043367709
Name:SHAH, SONAL S (MD)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 S LINDSAY RD
Mailing Address - Street 2:STE 126
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1506
Mailing Address - Country:US
Mailing Address - Phone:480-892-3500
Mailing Address - Fax:480-892-0695
Practice Address - Street 1:4100 S LINDSAY RD
Practice Address - Street 2:STE 126
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1508
Practice Address - Country:US
Practice Address - Phone:480-892-3500
Practice Address - Fax:480-892-0695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34629208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1829948OtherCIGNA
AZ7704200OtherAETNA US HEALTHCARE
AZ079121Medicaid
AZ3Z1175OtherHEALTHNET
AZ7704200OtherAETNA US HEALTHCARE