Healthcare Provider Details

I. General information

NPI: 1003405739
Provider Name (Legal Business Name): REBECCA ANNE SHAW PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E GREENWAY ST STE 1
MESA AZ
85203-4359
US

IV. Provider business mailing address

1131 S PHEASANT DR
GILBERT AZ
85296-3062
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-4742
  • Fax: 480-805-2184
Mailing address:
  • Phone: 480-296-4742
  • Fax: 480-805-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number262350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: