Healthcare Provider Details

I. General information

NPI: 1699477505
Provider Name (Legal Business Name): SHIVAM HARESH BHANVADIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD STE 200
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

3233 S MCCLINTOCK DR
TEMPE AZ
85282-5602
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-5525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: