Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Samuel

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1558112565

Shane Samuel is a Nurse Practitioner in Mesa, Arizona. Qualified in 2024, 2 years ago. Practices with Peak Mental Health LLC, a 9-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
2
Licensed in
AZ
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

10512 E Nichols Ave
Mesa, AZ 85209
Phone: (951) 217-9678
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 308310 (AZ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1558112565
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 28, 2024
Last updated in NPPESJuly 12, 2024
Certification dateJuly 12, 2024
Mailing address10512 E Nichols Ave., Mesa, AZ 85209

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Peak Mental Health Llc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Mesa