MEDICARE: SHANNON PATRICE VALENZUELA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	22718	AZ
2	207RP1001X	Pulmonary Disease Physician	22718	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22718	OTHER	AZ	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134118995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON PATRICE VALENZUELA MD

Provider Business Mailing Address
First Line	:	14300 W GRANITE VALLEY DR STE E23
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-5798
Country	:	US
Telephone Number	:	623-975-0500
Fax Number	:	623-975-0500

Provider Business Practice Location Address
First Line	:	14300 W GRANITE VALLEY DR STE E23
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-5798
Country	:	US
Telephone Number	:	623-975-0500
Fax Number	:	623-975-0705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	04/03/2026

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Directions to “ SHANNON PATRICE VALENZUELA MD” Practice Location

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