Healthcare Provider Details

I. General information

NPI: 1992811947
Provider Name (Legal Business Name): SHANON IONE HECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON IONE SCHULTZ

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 N TATUM BLVD SUITE 100
PHOENIX AZ
85028-1662
US

IV. Provider business mailing address

11130 N TATUM BLVD SUITE 100
PHOENIX AZ
85028-1662
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-1817
  • Fax: 602-494-7103
Mailing address:
  • Phone: 602-494-1817
  • Fax: 602-494-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35454
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101235064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: