Healthcare Provider Details

I. General information

NPI: 1134128564
Provider Name (Legal Business Name): SCOTT NATHAN SHEFTEL M.D, FAAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 E RIVER RD SUITE 201
TUCSON AZ
85718-5981
US

IV. Provider business mailing address

1595 E RIVER RD SUITE 201
TUCSON AZ
85718-5981
US

V. Phone/Fax

Practice location:
  • Phone: 520-293-5757
  • Fax: 520-293-7358
Mailing address:
  • Phone: 520-293-5757
  • Fax: 520-293-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: