Provider Demographics
NPI:1922827005
Name:FAHANDEZ SADI, SHAGHAYEGH (DMD)
Entity type:Individual
Prefix:
First Name:SHAGHAYEGH
Middle Name:
Last Name:FAHANDEZ SADI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 W BONANZA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5762
Mailing Address - Country:US
Mailing Address - Phone:602-393-8224
Mailing Address - Fax:
Practice Address - Street 1:2248 W BONANZA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5762
Practice Address - Country:US
Practice Address - Phone:602-393-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0121771223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice