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General NPI Number Information
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NPI Number | 1164138079
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Entity Type | Organization
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Legal Business Name | CREOSOTE PSYCHIATRY PLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 8380 S KYRENE RD STE D-103
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City | TEMPE
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State | AZ
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Zip | 85284-2120
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Country | US
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Telephone | 480-965-6341
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Fax | 480-674-1295
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Provider Business Mailing Address
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Address Line | 8380 S KYRENE RD STE D-103
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City | TEMPE
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State | AZ
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Zip | 85284-2120
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Country | US
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Telephone | 480-269-3208
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Fax | 480-674-1295
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SUZANNE TARIOT SHEARD
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Credential | DO
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Telephone | 585-737-5293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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