Healthcare Provider Details

I. General information

NPI: 1215558028
Provider Name (Legal Business Name): SANDRA GODIYA SHINKUT-AYANDELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 E BAYWOOD AVE
MESA AZ
85206-1797
US

IV. Provider business mailing address

6644 E BAYWOOD AVE
MESA AZ
85206-1747
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74011
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: