Provider Demographics
NPI:1982851648
Name:SHAH, SHEETAL (DO)
Entity Type:Individual
Prefix:DR
First Name:SHEETAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15608 N 71ST ST
Mailing Address - Street 2:APT 215
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5359
Mailing Address - Country:US
Mailing Address - Phone:917-583-8445
Mailing Address - Fax:
Practice Address - Street 1:15608 N 71ST ST
Practice Address - Street 2:APT 215
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5359
Practice Address - Country:US
Practice Address - Phone:917-583-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006464207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine