Healthcare Provider Details

I. General information

NPI: 1962881698
Provider Name (Legal Business Name): NISHI MADHUSUDAN SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 2500
PHOENIX AZ
85032-2151
US

IV. Provider business mailing address

21803 N SCOTTSDALE SUITE 290
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-4321
  • Fax: 602-253-5917
Mailing address:
  • Phone: 602-258-4321
  • Fax: 602-253-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME140126
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number60122
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: