Healthcare Provider Details

I. General information

NPI: 1205579398
Provider Name (Legal Business Name): ARIELLA SHAYANNA CHUNG CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date: 05/16/2025
Reactivation Date: 06/10/2025

III. Provider practice location address

2045 S VINEYARD STE 136
MESA AZ
85210-6891
US

IV. Provider business mailing address

650 S 97TH WAY
MESA AZ
85208-2540
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-5990
  • Fax:
Mailing address:
  • Phone: 623-272-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCPM25030686
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: