Individual
SHIFALI SHRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MD
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
6908 GLEN LANDING AVE, LAS VEGAS, NV 89130-4908
(702) 321-5526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
74612
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2020
Last updated
11/22/2024
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