Individual
SHANE E REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7615 W THUNDERBIRD RD, STE 106, PEORIA, AZ 85381-6083
(623) 773-2273
(623) 773-2274
Mailing address
PO BOX 9609, BELFAST, ME 04915-9609
(623) 773-2273
(623) 773-2274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3491
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173336
—
AZ
Enumeration date
10/02/2006
Last updated
09/09/2010
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