Provider Demographics
NPI:1720867120
Name:PITCOCK, SHANNON LYN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYN
Last Name:PITCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34250 N 60TH ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-5202
Mailing Address - Country:US
Mailing Address - Phone:480-596-9622
Mailing Address - Fax:
Practice Address - Street 1:34250 N 60TH ST BLDG C
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5202
Practice Address - Country:US
Practice Address - Phone:480-596-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach