Healthcare Provider Details

I. General information

NPI: 1114341906
Provider Name (Legal Business Name): SHEA PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 E DESERT COVE AVE #110
SCOTTSDALE AZ
85260-6775
US

IV. Provider business mailing address

8952 E DESERT COVE AVE #110
SCOTTSDALE AZ
85260-6775
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-3169
  • Fax:
Mailing address:
  • Phone: 480-767-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP5312
License Number StateAZ

VIII. Authorized Official

Name: MRS. LOKESWARI BUCCHIREDDIGARI
Title or Position: RN,FNP
Credential: FNP
Phone: 480-652-2931