Provider Demographics
NPI:1619114907
Name:KAVATHIA, SHAILEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILEE
Middle Name:
Last Name:KAVATHIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAILEE
Other - Middle Name:
Other - Last Name:SHUKLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4527
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-744-4799
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-262-8900
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ45952207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ720060Medicaid
AZZ154726Medicare PIN