Provider Demographics
NPI:1477037794
Name:SHAMS, MARCUS ARYA (ND)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ARYA
Last Name:SHAMS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20609 N 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6722
Mailing Address - Country:US
Mailing Address - Phone:631-960-6980
Mailing Address - Fax:
Practice Address - Street 1:2164 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1766
Practice Address - Country:US
Practice Address - Phone:480-428-3232
Practice Address - Fax:480-970-0003
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1730175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath