Individual
SHANNON ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19428 N MARICOPA RD, MARICOPA, AZ 85139-2850
(623) 273-6310
Mailing address
4138 E ERIE ST, GILBERT, AZ 85295-1019
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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