Healthcare Provider Details

I. General information

NPI: 1225635154
Provider Name (Legal Business Name): SHANNON NAPELEE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 09/22/2023
Certification Date: 09/30/2021
Deactivation Date: 09/30/2021
Reactivation Date: 09/22/2023

III. Provider practice location address

1617 SOUTH 67TH AVE
PHOENIX AZ
85043
US

IV. Provider business mailing address

3104 E CAMELBACK RD UNIT 7001
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-1715
  • Fax:
Mailing address:
  • Phone: 480-712-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: