Provider Demographics
NPI:1083946917
Name:PATIBANDLA, SUSHMITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMITHA
Middle Name:
Last Name:PATIBANDLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 N CIVIC CENTER PLZ
Mailing Address - Street 2:STE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6919
Mailing Address - Country:US
Mailing Address - Phone:623-879-6000
Mailing Address - Fax:623-516-2000
Practice Address - Street 1:20414 N 27TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3250
Practice Address - Country:US
Practice Address - Phone:623-879-6000
Practice Address - Fax:623-516-2000
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42999207RC0001X, 207RC0001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ526897Medicaid
AZZ155514Medicare PIN
AZZ157419Medicare PIN
AZZ138308Medicare PIN