Provider Demographics
NPI:1750481610
Name:IGHANI, SHAHLA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:IGHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N WYATT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6118
Mailing Address - Country:US
Mailing Address - Phone:520-795-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:2300 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2139
Practice Address - Country:US
Practice Address - Phone:520-881-1977
Practice Address - Fax:520-881-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89763207V00000X
AZ33687207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947327Medicaid
AZI40085Medicare UPIN
AZ947327Medicaid