Healthcare Provider Details

I. General information

NPI: 1326714874
Provider Name (Legal Business Name): MICHELLE SHAUGHNESSY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 N VENTURE DR UNIT D136
ANTHEM AZ
85086-3174
US

IV. Provider business mailing address

20401 N 73RD ST STE 230
SCOTTSDALE AZ
85255-4153
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax:
Mailing address:
  • Phone: 480-556-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: