Individual
PHDRA N SHABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
16427 N SCOTTSDALE RD STE 410, SCOTTSDALE, AZ 85254-7102
(888) 495-4489
(602) 325-0169
Mailing address
14050 N 83RD AVE STE 290, PEORIA, AZ 85381-5650
(888) 495-4489
(602) 325-0169
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1906
AZ
152W00000X
Optometrist
909
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
929136
—
AZ
Enumeration date
07/08/2009
Last updated
06/28/2019
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