Healthcare Provider Details

I. General information

NPI: 1750785358
Provider Name (Legal Business Name): ATRIA HEART PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16427 N SCOTTSDALE RD STE. 100
SCOTTSDALE AZ
85254-8197
US

IV. Provider business mailing address

PO BOX 13507
SCOTTSDALE AZ
85267-3507
US

V. Phone/Fax

Practice location:
  • Phone: 480-718-5072
  • Fax: 480-718-5074
Mailing address:
  • Phone: 480-718-5072
  • Fax: 480-718-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number41574
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number41574
License Number StateAZ

VIII. Authorized Official

Name: MAULIK G SHAH
Title or Position: MEMBER/MANAGER
Credential: M.D.
Phone: 415-235-9003