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NPI Code Detail

MEDICARE: SHEA PAIN PROFESSIONALS LLC

MEDICARE: SHEA PAIN PROFESSIONALS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0000XPain Medicine Physician
2363LF0000XFamily Nurse Practitioner
3363L00000XNurse Practitioner
4363A00000XPhysician Assistant
5208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1073247508
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEA PAIN PROFESSIONALS LLC
Provider Business Mailing Address
First Line : 1450 W GUADALUPE RD STE 124
Second Line :
City : GILBERT
State : AZ
Zip : 85233-3056
Country : US
Telephone Number : 480-307-8258
Fax Number : 480-454-8236
Provider Business Practice Location Address
First Line : 1450 W GUADALUPE RD STE 124
Second Line :
City : GILBERT
State : AZ
Zip : 85233-3056
Country : US
Telephone Number : 480-307-8258
Fax Number : 480-454-8236
Authorized Official
Title or Position : OWNER
Name : RADMAN RAHIMINEJAD
Credential :
Telephone Number : 480-307-8258
Provider Enumeration Date : 07/11/2022
Last Update Date : 02/06/2026

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Directions to “SHEA PAIN PROFESSIONALS LLC ” Practice Location

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