Provider Demographics
NPI:1073791810
Name:SHELLEY K. NAKAMURA,MD, PLLC
Entity Type:Organization
Organization Name:SHELLEY K. NAKAMURA,MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-568-2050
Mailing Address - Street 1:4727 E BELL RD
Mailing Address - Street 2:STE 45-411
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2308
Mailing Address - Country:US
Mailing Address - Phone:602-568-2050
Mailing Address - Fax:480-588-8353
Practice Address - Street 1:4727 E BELL RD
Practice Address - Street 2:STE 45-411
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2308
Practice Address - Country:US
Practice Address - Phone:602-568-2050
Practice Address - Fax:480-588-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120346Medicare PIN