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General NPI Number Information
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NPI Number | 1174978225
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Entity Type | Individual
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Provider Name | ROMY BIANCA SHANE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1919 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85016-7710
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Country | US
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Telephone | 602-933-0777
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Fax | 602-933-0755
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Provider Business Mailing Address
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Address Line | 2108 E THOMAS RD STE 130
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City | PHOENIX
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State | AZ
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Zip | 85016-0008
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Country | US
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Telephone | 602-933-1814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 58516
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 58516
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License Number State | AZ
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