Healthcare Provider Details

I. General information

NPI: 1235096173
Provider Name (Legal Business Name): SHAYTHECOACHACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 N DOBSON RD STE 110
MESA AZ
85201-7577
US

IV. Provider business mailing address

1061 N DOBSON RD STE 110
MESA AZ
85201-7577
US

V. Phone/Fax

Practice location:
  • Phone: 480-294-9952
  • Fax:
Mailing address:
  • Phone: 480-294-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWETA VASUDEVA
Title or Position: ACUPUNCTURIST
Credential: DAC
Phone: 480-294-9952