Provider Demographics
NPI:1164421426
Name:GOEL, SHASHI JAIN (MD PC INC)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:JAIN
Last Name:GOEL
Suffix:
Gender:F
Credentials:MD PC INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2445
Mailing Address - Country:US
Mailing Address - Phone:602-242-7500
Mailing Address - Fax:602-433-2644
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2445
Practice Address - Country:US
Practice Address - Phone:602-242-7500
Practice Address - Fax:602-433-2644
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388026Medicaid
F40314Medicare UPIN
AZZ114604Medicare PIN