Provider Demographics
NPI:1790983146
Name:SHELLY A FRIEDMAN
Entity Type:Organization
Organization Name:SHELLY A FRIEDMAN
Other - Org Name:SCOTTSDALE INSTITUTE FOR COSMETIC DERMATOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-970-0300
Mailing Address - Street 1:8800 EAST RAINTREE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-970-0300
Mailing Address - Fax:
Practice Address - Street 1:8800 EAST RAINTREE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6709
Practice Address - Country:US
Practice Address - Phone:480-970-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2179207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty