Provider Demographics
NPI:1972894095
Name:SHIJE, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SHIJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 W DUNLAP AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5823
Mailing Address - Country:US
Mailing Address - Phone:602-424-4450
Mailing Address - Fax:
Practice Address - Street 1:2423 W DUNLAP AVE STE 175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5823
Practice Address - Country:US
Practice Address - Phone:602-424-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012727572084N0400X
AZ507122084N0400X
NMMD2023-05212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ50712OtherAZ LICENSE