Healthcare Provider Details

I. General information

NPI: 1447576566
Provider Name (Legal Business Name): SHEENA AMY PRAKASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 2000
PHOENIX AZ
85020-2403
US

IV. Provider business mailing address

9250 N 3RD ST STE 2000
PHOENIX AZ
85020-2403
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1168
  • Fax:
Mailing address:
  • Phone: 602-861-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number52550
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number52550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: