Provider Demographics
NPI:1598949042
Name:SINGH, SHAKUNTLA (EDS)
Entity Type:Individual
Prefix:MS
First Name:SHAKUNTLA
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 N 135TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2294
Mailing Address - Country:US
Mailing Address - Phone:520-664-4533
Mailing Address - Fax:
Practice Address - Street 1:3802 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2368
Practice Address - Country:US
Practice Address - Phone:623-772-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2759526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2759526OtherARIZONA DEPARTMENT OF ED.