Healthcare Provider Details

I. General information

NPI: 1578280939
Provider Name (Legal Business Name): SHAUNA RAE NEWSHAM M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 112
MESA AZ
85206-4674
US

IV. Provider business mailing address

4838 E BASELINE RD STE 112
MESA AZ
85206-4674
US

V. Phone/Fax

Practice location:
  • Phone: 480-482-7098
  • Fax:
Mailing address:
  • Phone: 480-482-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP13804
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: