Provider Demographics
NPI:1114066149
Name:VARGHESE, FLENY SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FLENY
Middle Name:SUSAN
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:FLENY
Other - Middle Name:SUSAN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:34406 N 27TH DR BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6082
Mailing Address - Country:US
Mailing Address - Phone:602-344-9567
Mailing Address - Fax:602-344-9562
Practice Address - Street 1:34406 N 27TH DR STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-7730
Practice Address - Country:US
Practice Address - Phone:602-344-9567
Practice Address - Fax:602-344-9562
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ452672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ661046Medicaid
AZZ148280Medicare PIN