Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 62870 | AZ |
Y | 111NI0900X | Internist | 62870 | AZ |
N | 207RG0300X | Geriatric Medicine | 4301502133 | MI |
NPI | 1033643655 |
---|---|
Provider Name | Supriya Bhandari |
First Address | Phoenix, AZ 85012-2908 |
Second Address | Tempe, AZ 85282-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 30/09/2021 |