Healthcare Provider Details

I. General information

NPI: 1033524012
Provider Name (Legal Business Name): SHAILI GAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 W SOUTHERN AVE STE 102
MESA AZ
85202-4736
US

IV. Provider business mailing address

6835 E CAMELBACK RD
SCOTTSDALE AZ
85251-3119
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-5532
  • Fax:
Mailing address:
  • Phone: 954-670-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD1855902
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number59056
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: