Healthcare Provider Details

I. General information

NPI: 1629737390
Provider Name (Legal Business Name): SARA SHAYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N WILMOT RD STE 201
TUCSON AZ
85711-2701
US

IV. Provider business mailing address

603 N WILMOT RD STE 201
TUCSON AZ
85711-2701
US

V. Phone/Fax

Practice location:
  • Phone: 520-790-1556
  • Fax: 520-620-9719
Mailing address:
  • Phone: 520-790-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267602
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number267602
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: