Basic Information
| Provider Information | |||||||||
| NPI: | 1902883838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALEY | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 E THOMAS RD STE 230 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850123100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025570007 | ||||||||
| FaxNumber: | 6025570002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 E OSBORN RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022644431 | ||||||||
| FaxNumber: | 6022663870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 34654 | AZ | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | P00624719 | 01 | AZ | RAILROAD MEDICARE | OTHER | 345840 | 05 | AZ | MEDICAID | P01819220 | 01 | AZ | RAILROAD MEDICARE- ARIZONA UROLOGY SPECIALISTS | OTHER | Z197365 | 01 | AZ | MEDICARE FOR ARIZONA UROLOGY SPECIALISTS | OTHER |