Healthcare Provider Details

I. General information

NPI: 1962907873
Provider Name (Legal Business Name): SHEA GIAQUINTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E WARNER RD
GILBERT AZ
85296-3082
US

IV. Provider business mailing address

6036 N 19TH AVE STE 506
PHOENIX AZ
85015-2143
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-6600
  • Fax:
Mailing address:
  • Phone: 602-246-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63931
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: