MEDICARE: NEET ASHOK SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	64549	AZ

General Provider Information

NPI Number	:	1205326386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEET ASHOK SHAH

Provider Business Mailing Address
First Line	:	5427 W SAINT JOHN RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5384
Country	:	US
Telephone Number	:	602-328-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N CENTRAL AVE STE 1808
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2322
Country	:	US
Telephone Number	:	602-833-9666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	01/03/2023

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Directions to “ NEET ASHOK SHAH ” Practice Location

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