Provider Demographics
NPI:1447576566
Name:PRAKASH, SHEENA AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:AMY
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2164
Mailing Address - Country:US
Mailing Address - Phone:602-971-2761
Mailing Address - Fax:602-971-1529
Practice Address - Street 1:3815 E BELL RD STE 3400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-971-2761
Practice Address - Fax:602-971-1529
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ52550207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program