Provider Demographics
NPI:1760738124
Name:WU HALPERT, SAMANTHA SHANYI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:SHANYI
Last Name:WU HALPERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:SHANYI
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-839-6968
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:STE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-839-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ48967207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program