=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851624803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON LARA YORK N.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 10/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13802 N SCOTTSDALE RD SUITE 120, RM 9
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-389-0239
-----------------------------------------------------
Fax | 480-444-1471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13802 N SCOTTSDALE RD SUITE 120, RM 9
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-389-0239
-----------------------------------------------------
Fax | 480-444-1471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 05-901
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------