Healthcare Provider Details

I. General information

NPI: 1881328102
Provider Name (Legal Business Name): SHYON FAKHIMI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DOBSON RD
CHANDLER AZ
85224-5678
US

IV. Provider business mailing address

8340 E BASELINE RD APT 2075
MESA AZ
85209-5428
US

V. Phone/Fax

Practice location:
  • Phone: 480-814-1560
  • Fax:
Mailing address:
  • Phone: 480-322-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: