Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD000932 | AZ |
NPI | 1073976833 |
---|---|
Provider Name | Shannon Ganley |
First Address | Chandler, AZ 85286-2019 |
Second Address | Chandler, AZ 85286-2019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 19/07/2019 |