Organization
SHAFA MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA MODESTA M.D. (MEDICAL DIRECTOR /PRESIDENT)
(602) 248-8258
Entity
Organization
Contact information
Practice address
202 E EARLL DR STE 150, PHOENIX, AZ 85012-2636
(602) 248-8258
(602) 248-8259
Mailing address
202 E EARLL DR STE 150, PHOENIX, AZ 85012-2636
(602) 248-8258
(602) 248-8259
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
07569335N
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
447921
—
AZ
01
—
AZ0860140
BC/BS
AZ
Enumeration date
11/20/2007
Last updated
11/20/2007
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