Healthcare Provider Details

I. General information

NPI: 1396893608
Provider Name (Legal Business Name): SHAUNA MAZZULLA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 129
MESA AZ
85206-4673
US

IV. Provider business mailing address

7100 E LINCOLN DR UNIT 3157
PARADISE VALLEY AZ
85253-4454
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-6560
  • Fax:
Mailing address:
  • Phone: 206-390-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3661 TX
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: