Provider Demographics
NPI:1003211921
Name:SKYCREST NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:SKYCREST NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARASIMHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-219-7272
Mailing Address - Street 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:#D1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7610
Mailing Address - Country:US
Mailing Address - Phone:480-219-7272
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:#D1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-219-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty