MEDICARE: ONESOURCE SENIOR HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	231H00000X	Audiologist
3	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508272188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONESOURCE SENIOR HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	14050 N 83RD AVE STE 290
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-5650
Country	:	US
Telephone Number	:	888-495-4489
Fax Number	:	602-865-8090

Provider Business Practice Location Address
First Line	:	16427 N SCOTTSDALE RD STE 410
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-7102
Country	:	US
Telephone Number	:	888-495-4489
Fax Number	:	602-865-8090

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHDRA SHABA
Credential	:	OD
Telephone Number	:	888-495-4489

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/08/2024

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