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Shantala Mask, PA
Medical Physician Assistant in Phoenix, Arizona
NPI 1336304427

Shantala Mask is a Medical Physician Assistant based in Phoenix, AZ and is specialized in Medical. Shantala Mask practices in Phoenix, AZ and has the professional credentials of PA. The NPI Number for Shantala Mask is 1336304427 and holds a License No. 2911 (Arizona).

The current practice location address for Shantala Mask is 4136 N 75Th Ave, Phoenix, AZ and can be reached out via phone at 623-849-2220 and via fax at 623-849-2574.

Location: 4136 N 75Th Ave, Phoenix, AZ, 85033-3171
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Provider Profile Details
NPI Number
1336304427
Provider Name
Shantala Mask
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
4136 N 75Th Ave, Phoenix, AZ, 85033-3171
Phone Number
623-849-2220
Fax Number
623-849-2574
Provider Enumeration Date
07/28/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2911 01 AZ PHYSICIAN ASSISTANT LICENSE
institution
Provider Business Practice Location Address Details
Address
4136 N 75Th Ave
City
State
Zip
85033-3171
Phone Number
623-849-2220
Fax Number
623-849-2574
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Provider Business Mailing Address Details
Address
4136 N 75Th Ave
City
State
Zip
85033-3171
Phone Number
623-849-2220
Fax Number
623-849-2574
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Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
2911 (Arizona)
Definition
Definition to come...
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