Provider Demographics
NPI:1154508273
Name:SHEDOC, PLLC
Entity Type:Organization
Organization Name:SHEDOC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-774-3373
Mailing Address - Street 1:14435 N 7TH ST STE 300B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4385
Mailing Address - Country:US
Mailing Address - Phone:928-774-3373
Mailing Address - Fax:928-213-9206
Practice Address - Street 1:14435 N 7TH ST STE 300B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4385
Practice Address - Country:US
Practice Address - Phone:928-774-3373
Practice Address - Fax:928-213-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH34020Medicare UPIN
AZ66408Medicare PIN