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General NPI Number Information
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NPI Number | 1841989571
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Entity Type | Individual
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Provider Name | SHANA BURGOS-DESTEPHANIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 12000 W EMIGH RD
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City | TUCSON
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State | AZ
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Zip | 85743-9300
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Country | US
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Telephone | 520-616-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 7407 W TENDERFOOT DR
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City | TUCSON
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State | AZ
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Zip | 85757-8551
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Country | US
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Telephone | 520-977-3995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-005170
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License Number State | AZ
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