Healthcare Provider Details

I. General information

NPI: 1780913483
Provider Name (Legal Business Name): PHOENICIAN PAIN & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 N MCQUEEN RD
CHANDLER AZ
85225-8149
US

IV. Provider business mailing address

963 N MCQUEEN RD
CHANDLER AZ
85225-8149
US

V. Phone/Fax

Practice location:
  • Phone: 480-398-1940
  • Fax: 480-782-1453
Mailing address:
  • Phone: 480-398-1940
  • Fax: 480-782-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4954
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number36671
License Number StateAZ

VIII. Authorized Official

Name: SHIMUL B. SAHAI
Title or Position: MD.
Credential: M.D,
Phone: 480-398-1940