MEDICARE: DR. SHONA LAREE SHEWMAKER PH.D.

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	103TC0700X	Clinical Psychologist	3944	AZ

General Provider Information

NPI Number	:	1437323490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHONA LAREE SHEWMAKER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 74695
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85087-1012
Country	:	US
Telephone Number	:	479-871-0680
Fax Number	:	888-849-5696

Provider Business Practice Location Address
First Line	:	34975 N NORTH VALLEY PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-4028
Country	:	US
Telephone Number	:	479-871-0680
Fax Number	:

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

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	07/07/2011

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