Healthcare Provider Details

I. General information

NPI: 1639016876
Provider Name (Legal Business Name): SHANELLE LYNN BOYET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 W ROSE GARDEN LN STE 4
PHOENIX AZ
85027-2725
US

IV. Provider business mailing address

7001 E GOLF LINKS RD APT 126
TUCSON AZ
85730-1021
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-9912
  • Fax:
Mailing address:
  • Phone: 719-502-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: