Healthcare Provider Details

I. General information

NPI: 1386841252
Provider Name (Legal Business Name): SHALINI THARANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MAIN ST STE 104
MESA AZ
85203-8950
US

IV. Provider business mailing address

1345 E MAIN ST STE 104
MESA AZ
85203-8950
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-4741
  • Fax: 510-849-6694
Mailing address:
  • Phone: 480-300-4741
  • Fax: 510-849-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47443
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: