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General NPI Number Information
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NPI Number | 1720268618
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Entity Type | Individual
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Provider Name | MITAL SHAH M.M.S,.P.A-C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 755 E MCDOWELL RD FL 4
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City | PHOENIX
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State | AZ
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Zip | 85006-2506
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Country | US
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Telephone | 602-521-3090
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Fax | 602-521-3661
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Provider Business Mailing Address
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Address Line | 755 E MCDOWELL RD FL 4
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City | PHOENIX
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State | AZ
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Zip | 85006-2506
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Country | US
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Telephone | 602-521-3090
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Fax | 602-521-3661
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA189433
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2740
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License Number State | AZ
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