Healthcare Provider Details

I. General information

NPI: 1831908656
Provider Name (Legal Business Name): PLATINUM PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16421 N TATUM BLVD STE 124
PHOENIX AZ
85032-3455
US

IV. Provider business mailing address

16421 N TATUM BLVD STE 124
PHOENIX AZ
85032-3455
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-6422
  • Fax:
Mailing address:
  • Phone: 602-730-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD SHORTEN
Title or Position: OWNER
Credential: NP
Phone: 503-724-9102