Provider Demographics
NPI:1073325767
Name:MCDONALD, SHAWN (HAD)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545 W GRAND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7279
Mailing Address - Country:US
Mailing Address - Phone:623-975-0108
Mailing Address - Fax:
Practice Address - Street 1:14545 W GRAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7279
Practice Address - Country:US
Practice Address - Phone:623-975-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13652237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty