Provider Demographics
NPI:1992801005
Name:SHENNIB, HANI (MD)
Entity type:Individual
Prefix:
First Name:HANI
Middle Name:
Last Name:SHENNIB
Suffix:
Gender:M
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:PO BOX 7929
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7929
Mailing Address - Country:US
Mailing Address - Phone:480-722-7589
Mailing Address - Fax:480-857-8313
Practice Address - Street 1:3850 E BASELINE RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4403
Practice Address - Country:US
Practice Address - Phone:480-722-7589
Practice Address - Fax:480-857-8313
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ372-182086S0129X
AZ4885208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151193Medicaid
AZ860338466OtherTAX ID
AZP00356422OtherRAILROAD MEDICARE
AZWCSKQOtherSUN HEALTH GROUP#
AZ860338466OtherTAX ID
AZZ111727Medicare PIN