Provider Demographics
NPI:1790858462
Name:LANCASTER, SHANYN COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANYN
Middle Name:COLLEEN
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W BETHANY HOME RD # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2443
Mailing Address - Country:US
Mailing Address - Phone:623-537-6000
Mailing Address - Fax:602-433-6686
Practice Address - Street 1:2000 W BETHANY HOME RD # 2000
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:623-537-6000
Practice Address - Fax:602-433-6686
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161184207QS0010X
WI49929207QS0010X
AZ49465207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI462364641Medicare PIN
WI019940405Medicare PIN