Healthcare Provider Details

I. General information

NPI: 1275421471
Provider Name (Legal Business Name): SHALENE L. MILLER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 N 51ST AVE
PHOENIX AZ
85031-1716
US

IV. Provider business mailing address

4616 N 51ST AVE
PHOENIX AZ
85031-1716
US

V. Phone/Fax

Practice location:
  • Phone: 602-508-4447
  • Fax: 602-508-4492
Mailing address:
  • Phone: 602-685-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number252285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: