Healthcare Provider Details

I. General information

NPI: 1699980243
Provider Name (Legal Business Name): SHAREECE DAVIS-NELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 700
PHOENIX AZ
85013-4295
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-7048
  • Fax: 602-406-7650
Mailing address:
  • Phone: 602-406-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD436517
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA97214
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number60923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: