Individual
SHANI SAKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2632 N 20TH ST, PHOENIX, AZ 85006-1339
(602) 266-2200
(602) 240-6177
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 266-2200
(602) 240-6177
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4291
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4291
MEDICAL LICENSE
AZ
05
—
966070
—
AZ
01
—
P00255779
RAILROAD MEDICARE
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
08/29/2005
Last updated
11/01/2007
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