Healthcare Provider Details

I. General information

NPI: 1376724500
Provider Name (Legal Business Name): AMY SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY GOSALIA M.D.

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE STE 300
GLENDALE AZ
85308-7149
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 200
SCOTTSDALE AZ
85260-6280
US

V. Phone/Fax

Practice location:
  • Phone: 623-566-4718
  • Fax:
Mailing address:
  • Phone: 480-273-8510
  • Fax: 480-214-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number42638
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: