Organization
GAIA VIRTUAL MEDICINE. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEQIANG SHEN FNP (CEO)
(480) 876-4013
Entity
Organization
Contact information
Practice address
4494 W PEORIA AVE #115A, SUITE 8, GLENDALE, AZ 85302
(602) 626-4473
Mailing address
28913 N 23RD DR, PHOENIX, AZ 85085-0715
(602) 626-4473
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
09/12/2022
Last updated
05/20/2025
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