MEDICARE: SHELLEY K NAKAMURA MD

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
1	208600000X	Surgery Physician	30690	AZ

General Provider Information

NPI Number	:	1760463418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY K NAKAMURA MD

Provider Business Mailing Address
First Line	:	4727 E BELL RD
Second Line	:	STE 45-411
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2308
Country	:	US
Telephone Number	:	602-568-2050
Fax Number	:	480-588-8353

Provider Business Practice Location Address
First Line	:	4727 E BELL RD
Second Line	:	STE 45-411
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2308
Country	:	US
Telephone Number	:	602-568-2050
Fax Number	:	480-588-8353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/07/2023

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