Provider Demographics
NPI:1114105434
Name:SANJAY J. SHAH M.D. P.C.
Entity Type:Organization
Organization Name:SANJAY J. SHAH M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-842-7555
Mailing Address - Street 1:5523 W LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1231
Mailing Address - Country:US
Mailing Address - Phone:602-842-7555
Mailing Address - Fax:602-753-0183
Practice Address - Street 1:5523 W LARIAT LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1231
Practice Address - Country:US
Practice Address - Phone:602-842-7555
Practice Address - Fax:602-753-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty