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NPI Code Detail

MEDICARE: ELYSA SHAW M.D.

MEDICARE: ELYSA SHAW 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
1207Q00000XFamily Medicine Physician35212AZ

General Provider Information

NPI Number : 1902921984
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELYSA SHAW M.D.
Provider Business Mailing Address
First Line : 13838 S 46TH PL STE 125
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7802
Country : US
Telephone Number : 480-783-7000
Fax Number : 480-783-9071
Provider Business Practice Location Address
First Line : 13838 S 46TH PL STE 125
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7802
Country : US
Telephone Number : 480-783-7000
Fax Number : 480-783-9071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 03/27/2015

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