Healthcare Provider Details

I. General information

NPI: 1659020717
Provider Name (Legal Business Name): SHELBY LYNN MCGREW PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20402 N 15TH AVE
PHOENIX AZ
85027-3699
US

IV. Provider business mailing address

1617 W WOOD DR
PHOENIX AZ
85029-1753
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-5000
  • Fax:
Mailing address:
  • Phone: 623-879-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPSY-005487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: