Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D07677 | AZ |
NPI | 1043303001 |
---|---|
Provider Name | Dr. Shreedevi Thulasidas |
First Address | Scottsdale, AZ 85266-5241 |
Second Address | Scottsdale, AZ 85266-5241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 04/02/2016 |