Provider Demographics
NPI:1215360003
Name:ARIZONA DIABETES AND ENDOCRINOLOGY, PLC
Entity Type:Organization
Organization Name:ARIZONA DIABETES AND ENDOCRINOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHABEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-646-8433
Mailing Address - Street 1:2925 E RIGGS RD
Mailing Address - Street 2:STE 8-123
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3600
Mailing Address - Country:US
Mailing Address - Phone:480-646-8433
Mailing Address - Fax:480-646-8434
Practice Address - Street 1:3489 S MERCY RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0431
Practice Address - Country:US
Practice Address - Phone:480-646-8433
Practice Address - Fax:480-646-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47799207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47799OtherAZ LIC 47799