Provider Demographics
NPI:1720568454
Name:SHEPHERD, HANNAH
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20401 N 73RD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4153
Mailing Address - Country:US
Mailing Address - Phone:480-556-0446
Mailing Address - Fax:623-209-7669
Practice Address - Street 1:13995 W STATLER BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5512
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:623-209-7669
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant