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General NPI Number Information
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NPI Number | 1871176677
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Entity Type | Individual
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Provider Name | SHASHANK MITTAL MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 10401 W THUNDERBIRD BLVD
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City | SUN CITY
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State | AZ
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Zip | 85351-3004
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Country | US
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Telephone | 623-832-4728
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Fax |
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Provider Business Mailing Address
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Address Line | 10015 CATES CRK
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City | SAN ANTONIO
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State | TX
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Zip | 78255-3609
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Country | US
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Telephone | 469-271-8366
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 76435
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 76435
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License Number State | AZ
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