Provider Demographics
NPI:1588824007
Name:JAIN, SHASHANK (MD)
Entity Type:Individual
Prefix:
First Name:SHASHANK
Middle Name:
Last Name:JAIN
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 1:6343 E MAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8955
Mailing Address - Country:US
Mailing Address - Phone:480-835-6100
Mailing Address - Fax:
Practice Address - Street 1:6750 E BAYWOOD AVE STE 301
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:480-461-4243
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443397207RC0000X
AZ63803207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA227690Medicare PIN
PA227690Medicare PIN