Provider Demographics
NPI:1447321682
Name:SHAH, DEEPA (DC)
Entity type:Individual
Prefix:MRS
First Name:DEEPA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3702
Mailing Address - Country:US
Mailing Address - Phone:602-249-4508
Mailing Address - Fax:602-249-1614
Practice Address - Street 1:4527 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3702
Practice Address - Country:US
Practice Address - Phone:602-249-4508
Practice Address - Fax:602-249-1614
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor