SHAFA MEDICAL CLINIC PC
Ambulatory Health at Earll Dr, Phoenix, AZ

License number
Arizona 07569335N
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: DR. AMANDA MODESTA M.D.
Title: MEDICAL DIRECTOR /PRESIDENT
Phone: (602) 248-8258
Address
Address
202 E Earll Dr STE 150, Phoenix, AZ 85012
National Provider ID: 1194906925
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SHAFA MEDICAL CLINIC, PC

202 E Earll Dr #150, Phoenix, AZ 85012

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Shafa Medical Clinic<br>Shafa Medical - Amanda Modesta MD
Registration:
Jun 8, 1999
Site:
shafamedical.com
Phone:
(602) 274-6162 (Phone), (602) 248-8258 (Phone)
State ID:
-0877914-1
Expiration:
Perpetual
Vice-Presidents:
Amanda Modesta-Keyhani (President), 202 E Earll Dr #150, Phoenix, AZ 85012 (Physical),Michael Aeed (Principal),Amanda R. Modesta Internal Medicine, Medical Director, Medical Doctor, inactive,...
SIC6:
801100 - Medical doctor's office
Categories:
Anesthesiology Physicians, Internal Medicine Physicians & Surgeons, Physicians & Surgeons, ...
Payment options:
American Express, Visa
Company size:
6

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