Provider Demographics
NPI:1073622940
Name:DOOLEY, SHELLEY BERGER (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:BERGER
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 N TATUM BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1628
Mailing Address - Country:US
Mailing Address - Phone:602-443-2111
Mailing Address - Fax:602-443-2110
Practice Address - Street 1:11120 N TATUM BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1628
Practice Address - Country:US
Practice Address - Phone:602-443-2111
Practice Address - Fax:602-443-2110
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-034823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201392431OtherEIN #
AZ63199Medicare ID - Type Unspecified
AZP15508Medicare UPIN