Healthcare Provider Details

I. General information

NPI: 1033948088
Provider Name (Legal Business Name): SHAYNE SCOFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S IRONWOOD DR
APACHE JUNCTION AZ
85120-7100
US

IV. Provider business mailing address

2525 S IRONWOOD DR
APACHE JUNCTION AZ
85120-7100
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA14535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: