Individual
SHANTALA MASK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4136 N 75TH AVE, STE. 101, PHOENIX, AZ 85033-3171
(623) 849-2220
(623) 849-2574
Mailing address
4136 N 75TH AVE, STE. 101, PHOENIX, AZ 85033-3171
(623) 849-2220
(623) 849-2574
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2911
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2911
PHYSICIAN ASSISTANT LICENSE
AZ
Enumeration date
07/28/2008
Last updated
02/04/2014
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