Healthcare Provider Details

I. General information

NPI: 1982143756
Provider Name (Legal Business Name): SUN WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10192 W COGGINS DR
SUN CITY AZ
85351-3405
US

IV. Provider business mailing address

6449 E GAINSBOROUGH RD
SCOTTSDALE AZ
85251-1950
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-5828
  • Fax: 602-840-1290
Mailing address:
  • Phone: 480-812-5828
  • Fax: 602-840-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number6226
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number6226
License Number StateAZ

VIII. Authorized Official

Name: NINA M SHAH
Title or Position: OWNER/MEMBER MANAGER
Credential: D.O.
Phone: 480-812-5828