Provider Demographics
NPI:1700561446
Name:STUBBLEFIELD, SHAMEAL (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAMEAL
Middle Name:
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 N SILVERADO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-4303
Mailing Address - Country:US
Mailing Address - Phone:480-238-1777
Mailing Address - Fax:
Practice Address - Street 1:1917 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6216
Practice Address - Country:US
Practice Address - Phone:480-610-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ292962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily