Provider Demographics
NPI:1790295277
Name:SHABAN, DANIAH S (PA-C)
Entity type:Individual
Prefix:
First Name:DANIAH
Middle Name:S
Last Name:SHABAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 N 32ND ST STE 12
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7144
Mailing Address - Country:US
Mailing Address - Phone:602-951-0950
Mailing Address - Fax:
Practice Address - Street 1:3811 E BELL RD STE 309
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2160
Practice Address - Country:US
Practice Address - Phone:602-951-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10601363A00000X, 363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant