Provider Demographics
NPI:1760463418
Name:NAKAMURA, SHELLEY K (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:K
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4727 E BELL RD
Mailing Address - Street 2:STE 45-411
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2308
Mailing Address - Country:US
Mailing Address - Phone:602-568-2050
Mailing Address - Fax:480-588-8353
Practice Address - Street 1:4727 E BELL RD
Practice Address - Street 2:STE 45-411
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2308
Practice Address - Country:US
Practice Address - Phone:602-568-2050
Practice Address - Fax:480-588-8353
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ30690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBN7245500OtherDEA
AZBN7245500OtherDEA