Healthcare Provider Details

I. General information

NPI: 1679917025
Provider Name (Legal Business Name): ASHKAUN SHATERIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 04/09/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 W INDIAN SCHOOL RD
PHOENIX AZ
85037-5904
US

IV. Provider business mailing address

10240 W INDIAN SCHOOL RD
PHOENIX AZ
85037-5904
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-9077
  • Fax:
Mailing address:
  • Phone: 623-251-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number60516
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number60516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: