Provider Demographics
NPI:1508473950
Name:HERNDON, SHAYE LAUREN (NMD)
Entity Type:Individual
Prefix:
First Name:SHAYE
Middle Name:LAUREN
Last Name:HERNDON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:LAUREN
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NMD
Mailing Address - Street 1:5657 E NISBET RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2433
Mailing Address - Country:US
Mailing Address - Phone:602-367-9688
Mailing Address - Fax:
Practice Address - Street 1:906 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1730
Practice Address - Country:US
Practice Address - Phone:480-524-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1904175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath