Mondana Nicole Shamsazar, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D011727 Issued in AZ

Practice address

500 N Estrella Pkwy Ste B1
Goodyear, AZ 85338-4136

Phone

(623) 688-5408

NPI assigned

Aug 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goodyear Modern Dentistry, LLP

  • Dentist
  • Goodyear, AZ
  • NPI 1912497504
  NPD (past)
• Sleep Impressions, LLC

  • Specialist
  • Saint Louis, MO
  • NPI 1134547912

  Dentist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1831746932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15260 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952530",
            "telephone_number": "623-207-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY STE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384136",
            "telephone_number": "623-688-5408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15260 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952530",
            "country_code": "US",
            "telephone_number": "623-207-7838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20800 W Market St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Buckeye",
            "state": "AZ",
            "postal_code": "853968040",
            "country_code": "US",
            "telephone_number": "623-900-9996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMSAZAR",
        "first_name": "MONDANA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-22",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16999",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011727",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon L Seyedan, LCSW, LISAC
• Hind Shabany, M.D.
• Firas N Shadad, MD
• Shruti Shah, MD
• Anitha Shaju
• Toni Deneice Sharon, FNP-C
• Lawrence Eugene Shauf, PT
• Mary Shaw, SLP
• Abby Sheahan, LPC
• Cynthia Louise Shembab, LAMFT

• All providers in Goodyear, AZ
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.