Provider Demographics
NPI:1063736601
Name:CHANGHO, SHEELAH C (MD)
Entity type:Individual
Prefix:
First Name:SHEELAH
Middle Name:C
Last Name:CHANGHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 E INDIAN WELLS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4917
Mailing Address - Country:US
Mailing Address - Phone:913-219-3324
Mailing Address - Fax:
Practice Address - Street 1:1910 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1962
Practice Address - Country:US
Practice Address - Phone:520-247-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54951207ZP0101X
MO2008015503207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200679940AMedicaid
44273019OtherBCBS-KC
44273019OtherBCBS-KC
KS110363003Medicare PIN