Provider Demographics
NPI:1689978447
Name:DARA SHAHON, M.D., P.C.
Entity Type:Organization
Organization Name:DARA SHAHON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-947-4493
Mailing Address - Street 1:9811 N 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4527
Mailing Address - Country:US
Mailing Address - Phone:480-947-4493
Mailing Address - Fax:480-947-4751
Practice Address - Street 1:9811 N 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4527
Practice Address - Country:US
Practice Address - Phone:480-947-4493
Practice Address - Fax:480-947-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19123207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE54264Medicare UPIN