Healthcare Provider Details

I. General information

NPI: 1437189404
Provider Name (Legal Business Name): HETAL C. SHAH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N 51ST AVE STE 5
PHOENIX AZ
85031-1237
US

IV. Provider business mailing address

4700 N 51ST AVE STE 5
PHOENIX AZ
85031-1237
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7597
  • Fax: 623-846-1826
Mailing address:
  • Phone: 623-846-7597
  • Fax: 623-846-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HETAL C. SHAH
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 602-430-0940