Shannon Gray

NPI #1245553502 in Mesa, Arizona

Provider Information

NPI Number: 1245553502
Entity Type: Organization
Organization Name: Shannon Gray
Primary Specialty: Specialist
Enumeration Date: Mar 1, 2010
Last Updated: Mar 1, 2010

Practice Location

Address: 1111 S STAPLEY DR
Address 2: SUITE 111
City: Mesa
State: Arizona
ZIP Code: 85204-5059
Phone: (480) 398-1220

Authorized Official

Name: MISS SHANNON GRAY
Title: ADMINISTRATOR/OWNER
Phone: (480) 983-4200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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