Individual
SHANON IONE HECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11130 N TATUM BLVD, SUITE 100, PHOENIX, AZ 85028-1662
(602) 494-1817
(602) 494-7103
Mailing address
11130 N TATUM BLVD, SUITE 100, PHOENIX, AZ 85028-1662
(602) 494-1817
(602) 494-7103
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0101235064
VA
207N00000X
Dermatology Physician
Primary
35454
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010227844
—
VA
Enumeration date
08/22/2006
Last updated
12/04/2018
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