Healthcare Provider Details

I. General information

NPI: 1053050237
Provider Name (Legal Business Name): SHAW J MAHRE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 W CHANDLER BLVD BLDG B #8
CHANDLER AZ
85224-6177
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-1696
  • Fax: 480-963-6227
Mailing address:
  • Phone: 480-821-2838
  • Fax: 480-821-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9315
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: