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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