Provider Demographics
NPI:1427125905
Name:CHANDLER PEDIATRICS LLC
Entity type:Organization
Organization Name:CHANDLER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUMBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-782-5575
Mailing Address - Street 1:1850 W FRYE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6232
Mailing Address - Country:US
Mailing Address - Phone:480-782-5575
Mailing Address - Fax:480-782-5576
Practice Address - Street 1:1850 W FRYE RD STE 102
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6232
Practice Address - Country:US
Practice Address - Phone:480-782-5575
Practice Address - Fax:480-782-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27805261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486010Medicaid
F03158Medicare UPIN