Healthcare Provider Details

I. General information

NPI: 1043367709
Provider Name (Legal Business Name): SONAL S SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 126
GILBERT AZ
85297-1508
US

IV. Provider business mailing address

4100 S LINDSAY RD STE 126
GILBERT AZ
85297-1506
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-3500
  • Fax: 480-892-0695
Mailing address:
  • Phone: 480-892-3500
  • Fax: 480-892-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: