Provider Demographics
NPI:1568788099
Name:PANDEY, SUSHIL RAJ (MD)
Entity Type:Individual
Prefix:
First Name:SUSHIL
Middle Name:RAJ
Last Name:PANDEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:18715 N REEMS RD STE 140
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8643
Practice Address - Country:US
Practice Address - Phone:623-440-6591
Practice Address - Fax:623-440-8142
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ43251208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ519058Medicaid