Provider Demographics
NPI:1457666570
Name:SHETA, MOHAMED ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ALI
Last Name:SHETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:480-480-8330
Mailing Address - Fax:480-393-0242
Practice Address - Street 1:13656 BRETON RIDGE ST UNIT A&H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6081
Practice Address - Country:US
Practice Address - Phone:281-429-8780
Practice Address - Fax:281-763-7930
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4871207R00000X, 207RN0300X
SC37459207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC374598Medicaid
SC58117244Medicare PIN