Healthcare Provider Details

I. General information

NPI: 1255035606
Provider Name (Legal Business Name): SHANNON YEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E VAN BUREN ST
AVONDALE AZ
85323-1506
US

IV. Provider business mailing address

8088 W WHITNEY DR
PEORIA AZ
85345-6564
US

V. Phone/Fax

Practice location:
  • Phone: 833-855-9973
  • Fax: 602-655-9680
Mailing address:
  • Phone: 602-344-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012469
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: