Healthcare Provider Details

I. General information

NPI: 1033430335
Provider Name (Legal Business Name): SHAWN MICHAEL STEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE # 330
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

2910 N 3RD AVE # 330
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax: 602-406-8810
Mailing address:
  • Phone: 602-406-8811
  • Fax: 602-406-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57.025704
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number54293
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: