Healthcare Provider Details

I. General information

NPI: 1104758077
Provider Name (Legal Business Name): SCOTTSDALE FACIAL AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 E RAINTREE DR STE 200
SCOTTSDALE AZ
85260-7307
US

IV. Provider business mailing address

PO BOX 15402
SCOTTSDALE AZ
85267-5402
US

V. Phone/Fax

Practice location:
  • Phone: 602-830-8513
  • Fax:
Mailing address:
  • Phone: 480-752-7874
  • Fax: 888-732-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JINESH SHAH
Title or Position: OWNER
Credential: MD
Phone: 503-706-9934