Provider Demographics
NPI:1164864161
Name:PATWARDHAN, SURABHI YESHWANT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SURABHI
Middle Name:YESHWANT
Last Name:PATWARDHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 S PRICE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3544
Mailing Address - Country:US
Mailing Address - Phone:480-855-4011
Mailing Address - Fax:
Practice Address - Street 1:3550 N CENTRAL AVE STE 1407
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2112
Practice Address - Country:US
Practice Address - Phone:602-216-6900
Practice Address - Fax:602-371-9889
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
AZ4454103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist