Provider Demographics
NPI:1497918502
Name:BADHWAR, SHRUTI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:BADHWAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHRUTI
Other - Middle Name:BADHWAR
Other - Last Name:PARASHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2122 E HIGHLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4740
Mailing Address - Country:US
Mailing Address - Phone:804-283-3764
Mailing Address - Fax:480-428-3377
Practice Address - Street 1:2122 E HIGHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4740
Practice Address - Country:US
Practice Address - Phone:804-283-3764
Practice Address - Fax:480-428-3377
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0057482084N0600X
NY2562982084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ654521Medicaid