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NPI Code Detail

MEDICARE: SHAWN FAZEL M.D.

MEDICARE: SHAWN FAZEL M.D.
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
1207R00000XInternal Medicine Physician41504AZ
2207R00000XInternal Medicine PhysicianRI11743RI

General Provider Information

NPI Number : 1861444986
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN FAZEL M.D.
Provider Business Mailing Address
First Line : 2451 S ROANOKE ST
Second Line :
City : GILBERT
State : AZ
Zip : 85295-2369
Country : US
Telephone Number : 401-529-6111
Fax Number :
Provider Business Practice Location Address
First Line : 5102 W CAMPBELL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85031-1703
Country : US
Telephone Number : 623-848-5180
Fax Number : 623-848-5178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/17/2020

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