Basic Information
| Provider Information | |||||||||
| NPI: | 1295976538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | SHAYNA | ||||||||
| MiddleName: | CAROLINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROBERTS & ROBERTS-KLEIN | ||||||||
| OtherFirstName: | SHAYNA | ||||||||
| OtherMiddleName: | CAROLINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2323 W ROSE GARDEN LN | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850272530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025216252 | ||||||||
| FaxNumber: | 6238425640 | ||||||||
| Practice Location | |||||||||
| Address1: | 10401 W THUNDERBIRD BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238324000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2009 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | 45044 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 45044 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1295976538 | 01 | AZ | PHYSICIAN INDIVIDUAL NPI | OTHER | 1841261989 | 01 | AZ | GROUP NPI | OTHER | 628578 | 05 | AZ | MEDICAID | ZWCBBM | 01 | AZ | GROUP MEDICARE ID | OTHER | CS7943 | 01 | AZ | GROUP MEDICARE RAILROAD ID & PTAN | OTHER | 005472 | 01 | AZ | GROUP MEDICAID ID | OTHER | P01038305 | 01 | AZ | PHYSICIAN MEDICARE RAILROAD ID | OTHER |