Healthcare Provider Details

I. General information

NPI: 1215485529
Provider Name (Legal Business Name): SHAUNDA AYLENE BUENO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 12/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 S CANDY LN
COTTONWOOD AZ
86326
US

IV. Provider business mailing address

1830 S COYOTE HILL RD
CLARKDALE AZ
86324-3500
US

V. Phone/Fax

Practice location:
  • Phone: 928-639-6174
  • Fax:
Mailing address:
  • Phone: 928-300-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8976
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8976
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: