Healthcare Provider Details

I. General information

NPI: 1487344628
Provider Name (Legal Business Name): SHAWN STRASH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 E SUTTON DR
SCOTTSDALE AZ
85260-4125
US

IV. Provider business mailing address

8402 E SUTTON DR
SCOTTSDALE AZ
85260-4125
US

V. Phone/Fax

Practice location:
  • Phone: 602-320-7154
  • Fax:
Mailing address:
  • Phone: 602-320-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: