Basic Information
Provider Information
NPI: 1063446656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GANDHI-LIST
FirstName: SHEFALI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9305 W THOMAS RD
Address2: STE 155
City: PHOENIX
State: AZ
PostalCode: 850373360
CountryCode: US
TelephoneNumber: 6503665594
FaxNumber: 6503666352
Practice Location
Address1: 9305 W THOMAS RD STE 155
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850370910
CountryCode: US
TelephoneNumber: 6239361780
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 12/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X45803AZY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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