Healthcare Provider Details

I. General information

NPI: 1922963099
Provider Name (Legal Business Name): SHIELDED PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43938 W PALO OLMO RD
MARICOPA AZ
85138-3617
US

IV. Provider business mailing address

43938 W PALO OLMO RD
MARICOPA AZ
85138-3617
US

V. Phone/Fax

Practice location:
  • Phone: 480-422-4575
  • Fax:
Mailing address:
  • Phone: 480-422-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRESHONNA GREEN
Title or Position: OWNER
Credential:
Phone: 480-422-4575