Individual
SHASTA ELIZABETH HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5601 W EUGIE AVE STE 100, GLENDALE, AZ 85304-1256
(602) 865-4510
Mailing address
1208 RED BUCKEYE CT, MONCKS CORNER, SC 29461-8600
(310) 721-8870
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
74368
AZ
207XX0801X
Orthopaedic Trauma Physician
83022
SC
Other
Enumeration date
05/21/2013
Last updated
05/11/2025
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