Healthcare Provider Details

I. General information

NPI: 1780687087
Provider Name (Legal Business Name): SHAYNA M MANSFIELD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E SHEA BLVD STE 130
PHOENIX AZ
85028-3061
US

IV. Provider business mailing address

4545 E SHEA BLVD STE 130
PHOENIX AZ
85028-3061
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-9532
  • Fax: 480-664-3482
Mailing address:
  • Phone: 480-292-9532
  • Fax: 602-324-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4036
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: