Provider Demographics
NPI:1679520522
Name:NARAYANAPPA, ARUNDATHI P (PA)
Entity type:Individual
Prefix:MISS
First Name:ARUNDATHI
Middle Name:P
Last Name:NARAYANAPPA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:SUITE #190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-940-5420
Mailing Address - Fax:480-940-5480
Practice Address - Street 1:11034 N 23RD DR # 105B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4743
Practice Address - Country:US
Practice Address - Phone:602-639-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104751Medicare ID - Type UnspecifiedPV LOCATION
AZZ127774Medicare PIN
AZZ131406Medicare PIN
AZ104750Medicare ID - Type UnspecifiedPHX LOCATION
AZZ127773Medicare PIN
AZS54441Medicare UPIN
AZZ130655Medicare PIN