Provider Demographics
NPI:1124833363
Name:SHIBLEY, BRENDON J
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:J
Last Name:SHIBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W PECOS RD APT 2113
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7613
Mailing Address - Country:US
Mailing Address - Phone:760-920-4214
Mailing Address - Fax:
Practice Address - Street 1:585 N JUNIPER DR STE 150
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2560
Practice Address - Country:US
Practice Address - Phone:480-499-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ237599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily