Provider Demographics
NPI:1457314841
Name:KUMAR, SHYAMALA (MD)
Entity Type:Individual
Prefix:
First Name:SHYAMALA
Middle Name:
Last Name:KUMAR
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 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:STE D148
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3769
Mailing Address - Country:US
Mailing Address - Phone:602-843-3811
Mailing Address - Fax:602-843-0044
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:STE D148
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3769
Practice Address - Country:US
Practice Address - Phone:602-843-3811
Practice Address - Fax:602-843-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7728238Medicaid
AZ569353Medicaid
AZ7728238Medicaid
AZBOX3374891Medicare ID - Type Unspecified