Healthcare Provider Details

I. General information

NPI: 1639827041
Provider Name (Legal Business Name): MS. MAUHASIN J FAGG-DAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 E SHEA BLVD #164, PHOENIX, AZ 85028
PHOENIX AZ
85028
US

IV. Provider business mailing address

5040 E SHEA BLVD #164,
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-1165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: