Provider Demographics
NPI:1942403076
Name:SHOSAMANA
Entity Type:Organization
Organization Name:SHOSAMANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:ZIV
Authorized Official - Suffix:
Authorized Official - Credentials:PSY MHNP
Authorized Official - Phone:480-325-0313
Mailing Address - Street 1:3740 E SOUTHERN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2512
Mailing Address - Country:US
Mailing Address - Phone:480-325-0313
Mailing Address - Fax:480-324-0631
Practice Address - Street 1:3740 E SOUTHERN AVE STE 207
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2512
Practice Address - Country:US
Practice Address - Phone:480-325-0313
Practice Address - Fax:480-324-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN045016AP0033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty