Healthcare Provider Details

I. General information

NPI: 1770919391
Provider Name (Legal Business Name): MRS. SHANNON SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 W FRYE RD STE 5
CHANDLER AZ
85224-6273
US

IV. Provider business mailing address

14780 W MOUNTAIN VIEW BLVD STE 110
SURPRISE AZ
85374-7280
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3600
  • Fax: 480-821-3610
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-821-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5366
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: