Provider Demographics
NPI:1912214586
Name:SHAYNE, SIMA J (FNP)
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:J
Last Name:SHAYNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-464-5200
Mailing Address - Fax:480-907-2108
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-464-5200
Practice Address - Fax:480-907-2108
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily