Provider Demographics
NPI:1699093518
Name:THAKER, SHEETAL (MD)
Entity type:Individual
Prefix:
First Name:SHEETAL
Middle Name:
Last Name:THAKER
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 1:1925 W RIVER RD
Mailing Address - Street 2:APARTMENT #9107
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1464
Mailing Address - Country:US
Mailing Address - Phone:732-824-2583
Mailing Address - Fax:
Practice Address - Street 1:1925 W RIVER RD
Practice Address - Street 2:APARTMENT #9107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1464
Practice Address - Country:US
Practice Address - Phone:732-824-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197572207P00000X, 390200000X
TXP5139207P00000X
AZ51707207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program