Healthcare Provider Details

I. General information

NPI: 1730419086
Provider Name (Legal Business Name): SHEETAL WADERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2010
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5885
  • Fax:
Mailing address:
  • Phone: 602-344-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR71485
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number50812
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: