Basic Information
| Provider Information | |||||||||
| NPI: | 1730331364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHENOY | ||||||||
| FirstName: | SUNDEEP | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6567 E CARONDELET DR STE 225 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR STE 225 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 04/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 48140 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 48140 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208M00000X | 48140 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RI0011X | 48140 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 7100175260 | 05 | KY | MEDICAID | 201026720 | 05 | IN | MEDICAID | 0051440 | 05 | OH | MEDICAID |