Provider Demographics
NPI:1790547016
Name:SCHNEIDER, SHANNON M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 E TURQUOISE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3970
Mailing Address - Country:US
Mailing Address - Phone:623-329-9490
Mailing Address - Fax:
Practice Address - Street 1:3501 E TURQUOISE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3970
Practice Address - Country:US
Practice Address - Phone:623-329-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP302869363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health