Provider Demographics
NPI:1235442724
Name:SUKEY, SHAUNNA JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNNA
Middle Name:JEAN
Last Name:SUKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1312
Mailing Address - Country:US
Mailing Address - Phone:623-772-4411
Mailing Address - Fax:723-772-4220
Practice Address - Street 1:1406 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1312
Practice Address - Country:US
Practice Address - Phone:623-772-4411
Practice Address - Fax:723-772-4220
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4294120103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool