Provider Demographics
NPI:1851362602
Name:SHAKOOR, SUMBUL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMBUL
Middle Name:
Last Name:SHAKOOR
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 1:1850 W FRYE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6232
Mailing Address - Country:US
Mailing Address - Phone:480-782-5575
Mailing Address - Fax:480-782-5576
Practice Address - Street 1:1850 W FRYE RD STE 102
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6232
Practice Address - Country:US
Practice Address - Phone:480-782-5575
Practice Address - Fax:480-782-5576
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486010Medicaid
F03158Medicare UPIN