Provider Demographics
NPI:1528244365
Name:GOSALIA, SHEETAL DESAI (DO)
Entity type:Individual
Prefix:
First Name:SHEETAL
Middle Name:DESAI
Last Name:GOSALIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:4131 N 24TH ST
Practice Address - Street 2:ST. B102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6262
Practice Address - Country:US
Practice Address - Phone:602-955-6632
Practice Address - Fax:602-381-1341
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1057OtherTRAINING PERMIT