Healthcare Provider Details

I. General information

NPI: 1720268618
Provider Name (Legal Business Name): MITAL SHAH M.M.S,.P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD FL 4
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 E MCDOWELL RD FL 4
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3090
  • Fax: 602-521-3661
Mailing address:
  • Phone: 602-521-3090
  • Fax: 602-521-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA189433
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2740
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: