Organization
EAST VALLEY INFECTIOUS DISEASE MEDICINE LLC
Active
Organization
EAST VALLEY INFECTIOUS DISEASE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHASHIKALA AMENENI MD (AUTHORIZED SIGNER)
(480) 648-7895
Entity
Organization
Contact information
Practice address
6040 E MAIN ST # 516, MESA, AZ 85205-8928
(480) 648-7895
(623) 552-3320
Mailing address
EVIDM LOCKBOX DEPT 880778, PO BOX 29650, PHOENIX, AZ 85038-9650
(480) 648-7895
(623) 552-3320
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
09/12/2023
Last updated
04/23/2025
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