Reynolds, Shane E

Reynolds, Shane E is an individual health care provider with primary practice located at 7615 W Thunderbird Rd Ste 106, Peoria AZ 85381-6083. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Reynolds, Shane E can be contacted via phone (623) 773-2273.

Contact Information

Primary practice address
7615 W Thunderbird Rd Ste 106 Peoria AZ 85381-6083
Phone: (623) 773-2273
Fax: (623) 773-2274
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3491 Arizona

Profile Details

NPI number 1285727859
LBN Legal business name Reynolds, Shane E
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Sep 9th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285727859 NPPES
Arizona MEDICAID 173336

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