Healthcare Provider Details

I. General information

NPI: 1225201395
Provider Name (Legal Business Name): SHELLI HANKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 N PROFESSIONAL PARK DR STE120
TUCSON AZ
85704-7878
US

IV. Provider business mailing address

4811 E GRANT RD STE 216
TUCSON AZ
85712-2771
US

V. Phone/Fax

Practice location:
  • Phone: 520-618-6445
  • Fax: 520-743-5443
Mailing address:
  • Phone: 520-618-1010
  • Fax: 520-784-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number32019
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: