Healthcare Provider Details

I. General information

NPI: 1679549018
Provider Name (Legal Business Name): SHENEN LEAVITT DIETRICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHENEN LEAVITT DO

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

9377 E BELL RD
SCOTTSDALE AZ
85260-1502
US

V. Phone/Fax

Practice location:
  • Phone: 480-261-9409
  • Fax: 480-619-4098
Mailing address:
  • Phone: 480-619-4097
  • Fax: 480-619-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3379
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number3379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: