Healthcare Provider Details

I. General information

NPI: 1790547016
Provider Name (Legal Business Name): SHANNON M SCHNEIDER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 N METRO PKWY W
PHOENIX AZ
85051-1402
US

IV. Provider business mailing address

9610 N METRO PKWY W
PHOENIX AZ
85051-1402
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone: 480-964-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP302869
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: