Provider Demographics
NPI:1710944061
Name:SHAH, SANDEEP K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:K
Last Name:SHAH
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:PO BOX 8022
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-8022
Mailing Address - Country:US
Mailing Address - Phone:480-636-1149
Mailing Address - Fax:480-452-0998
Practice Address - Street 1:1955 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6282
Practice Address - Country:US
Practice Address - Phone:480-935-0108
Practice Address - Fax:480-939-4879
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32778208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ878051-01Medicaid
AZZ83714Medicare PIN
AZ878051-01Medicaid