Provider Demographics
NPI:1336664127
Name:PARADISE VALLEY PAIN AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:PARADISE VALLEY PAIN AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-473-7246
Mailing Address - Street 1:4400 N SCOTTSDALE RD # 9717
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3331
Mailing Address - Country:US
Mailing Address - Phone:480-473-7246
Mailing Address - Fax:480-473-4942
Practice Address - Street 1:5051 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7912
Practice Address - Country:US
Practice Address - Phone:480-473-7246
Practice Address - Fax:480-473-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE