Provider Demographics
NPI:1578218715
Name:ZANGANA, SHADAN (OD)
Entity type:Individual
Prefix:DR
First Name:SHADAN
Middle Name:
Last Name:ZANGANA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 W FRYE RD APT 3085
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24921 S ELLSWORTH RD STE 140
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-1579
Practice Address - Country:US
Practice Address - Phone:480-564-2682
Practice Address - Fax:480-564-2683
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty