Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0600X | Clinical Neurophysiologist | 005748 | AZ |
NPI | 1497918502 |
---|---|
Provider Name | Dr. Shruti Badhwar |
First Address | Phoenix, AZ 85016-4740 |
Second Address | Phoenix, AZ 85016-4740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
654521 | (05) | AZ |