Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 42999 | AZ |
NPI | 1083946917 |
---|---|
Provider Name | Dr. Sushmitha Patibandla |
First Address | Scottsdale, AZ 85251-6919 |
Second Address | Phoenix, AZ 85027-3250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2010 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
526897 | (05) | AZ |