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NPI Code Detail

MEDICARE: DR. SHANE M DALEY M.D.

MEDICARE: DR. SHANE M DALEY 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
1208800000XUrology Physician34654AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00624719OTHERAZRAILROAD MEDICARE
3P01819220OTHERAZRAILROAD MEDICARE- ARIZONA UROLOGY SPECIALISTS
4Z197365OTHERAZMEDICARE FOR ARIZONA UROLOGY SPECIALISTS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902883838
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE M DALEY M.D.
Provider Business Mailing Address
First Line : 77 E THOMAS RD STE 230
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-3100
Country : US
Telephone Number : 602-557-0007
Fax Number : 602-557-0002
Provider Business Practice Location Address
First Line : 1313 E OSBORN RD STE 150
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-5688
Country : US
Telephone Number : 602-264-4431
Fax Number : 602-266-3870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/21/2022

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