Provider Demographics
NPI:1902883838
Name:DALEY, SHANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:M
Last Name:DALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-557-0007
Mailing Address - Fax:602-557-0002
Practice Address - Street 1:1313 E OSBORN RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5688
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-266-3870
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ34654208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00624719OtherRAILROAD MEDICARE
AZ345840Medicaid
AZP01819220OtherRAILROAD MEDICARE- ARIZONA UROLOGY SPECIALISTS
AZZ197365OtherMEDICARE FOR ARIZONA UROLOGY SPECIALISTS
AZZ137948Medicare PIN