Healthcare Provider Details

I. General information

NPI: 1902927981
Provider Name (Legal Business Name): SHEFALI GOEL GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9746 N 90TH PL SUITE 205
SCOTTSDALE AZ
85258-5044
US

IV. Provider business mailing address

2149 E WARNER RD SUITE 102
TEMPE AZ
85284-3494
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6100
  • Fax: 480-464-0189
Mailing address:
  • Phone: 480-610-6100
  • Fax: 480-464-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number49843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: