1114932795 NPI number — STEFANY D SHAIBI DPT

Table of content: STEFANY D SHAIBI DPT (NPI 1114932795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114932795 NPI number — STEFANY D SHAIBI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAIBI
Provider First Name:
STEFANY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPEARS
Provider Other First Name:
STEFANY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114932795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 S ARIZONA AVE
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85286-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-726-3305
Provider Business Mailing Address Fax Number:
480-726-3508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 S ARIZONA AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286-6511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-726-3305
Provider Business Practice Location Address Fax Number:
480-726-3508
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7432 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7432 . This is a "PT LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com