Healthcare Provider Details

I. General information

NPI: 1679408793
Provider Name (Legal Business Name): AYELET F SHINA WANDROVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

14561 N 99TH ST
SCOTTSDALE AZ
85260-3827
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7402
  • Fax:
Mailing address:
  • Phone: 480-434-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberR81344
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: