Healthcare Provider Details

I. General information

NPI: 1497490056
Provider Name (Legal Business Name): SHPS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CRISMON RD
MESA AZ
85209-3767
US

IV. Provider business mailing address

5 COWBOYS WAY STE 300
FRISCO TX
75034-2074
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALDO RUFFOLO
Title or Position: PRESIDENT
Credential: DO
Phone: 312-576-4285