Healthcare Provider Details

I. General information

NPI: 1255035606
Provider Name (Legal Business Name): SHANNON YEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

V. Phone/Fax

Practice location:
  • Phone: 951-533-8373
  • Fax:
Mailing address:
  • Phone: 623-537-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012469
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: