Provider Demographics
NPI:1851624803
Name:YORK, SHANNON LARA (NMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LARA
Last Name:YORK
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13802 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 120, RM 9
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3458
Mailing Address - Country:US
Mailing Address - Phone:480-389-0239
Mailing Address - Fax:480-444-1471
Practice Address - Street 1:13802 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 120, RM 9
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3458
Practice Address - Country:US
Practice Address - Phone:480-389-0239
Practice Address - Fax:480-444-1471
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-901175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath