Provider Demographics
NPI:1275073223
Name:SHINE, JAHAZ N (NMD)
Entity Type:Individual
Prefix:DR
First Name:JAHAZ
Middle Name:N
Last Name:SHINE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 E VIA LINDA # H136
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5329
Mailing Address - Country:US
Mailing Address - Phone:480-289-3694
Mailing Address - Fax:480-289-3694
Practice Address - Street 1:10155 E VIA LINDA # H136
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5329
Practice Address - Country:US
Practice Address - Phone:480-289-3694
Practice Address - Fax:480-289-3694
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND874175F00000X
AZ191767175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMS4369371OtherDEA