Provider Demographics
NPI:1275421471
Name:MILLER, SHALENE L (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHALENE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1716
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:
Practice Address - Street 1:4616 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1716
Practice Address - Country:US
Practice Address - Phone:602-508-4447
Practice Address - Fax:602-508-4492
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ252285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health