Provider Demographics
NPI:1205579398
Name:CHUNG, ARIELLA SHAYANNA (CPM, LM)
Entity type:Individual
Prefix:
First Name:ARIELLA
Middle Name:SHAYANNA
Last Name:CHUNG
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S 97TH WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2540
Mailing Address - Country:US
Mailing Address - Phone:623-272-8275
Mailing Address - Fax:
Practice Address - Street 1:2045 S VINEYARD STE 136
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6891
Practice Address - Country:US
Practice Address - Phone:480-565-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2025-06-15
Deactivation Date:2025-05-16
Deactivation Code:
Reactivation Date:2025-06-10
Provider Licenses
StateLicense IDTaxonomies
AZ374J00000X
AZCPM25030686367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula