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General NPI Number Information
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NPI Number | 1235274051
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Entity Type | Organization
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Legal Business Name | GREAT DESTINATIONS PEDIATRICS
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 7757 W DEER VALLEY RD SUITE 275
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City | PEORIA
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State | AZ
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Zip | 85382-2118
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Country | US
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Telephone | 623-878-2800
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Fax | 623-878-9150
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Provider Business Mailing Address
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Address Line | 7757 W DEER VALLEY RD STE 275
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City | PEORIA
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State | AZ
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Zip | 85382-2130
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Country | US
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Telephone | 623-878-2800
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Fax | 623-878-9150
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Authorized Official
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Title or Position | OWNER/PHYSICIAN OWNER
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Name | DR. KRISTIN SHEPHERD
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Credential | MD
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Telephone | 623-878-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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