Healthcare Provider Details

I. General information

NPI: 1215360003
Provider Name (Legal Business Name): ARIZONA DIABETES AND ENDOCRINOLOGY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3489 S MERCY RD STE 101
GILBERT AZ
85297-0431
US

IV. Provider business mailing address

2925 E RIGGS RD STE 8-123
CHANDLER AZ
85249-3600
US

V. Phone/Fax

Practice location:
  • Phone: 480-646-8433
  • Fax: 480-646-8434
Mailing address:
  • Phone: 480-646-8433
  • Fax: 480-646-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number47799
License Number StateAZ

VIII. Authorized Official

Name: SHABEENA SHAIK
Title or Position: OWNER-PHYSICIAN
Credential: MD
Phone: 480-646-8433