Provider Demographics
NPI:1649776105
Name:SUSAN DEL SORDI STAATS, DO PLLC
Entity Type:Organization
Organization Name:SUSAN DEL SORDI STAATS, DO PLLC
Other - Org Name:ESSENTIAL FAMILY HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL SORDI STAATS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-285-2180
Mailing Address - Street 1:11209 N TATUM BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3092
Mailing Address - Country:US
Mailing Address - Phone:480-285-2180
Mailing Address - Fax:480-285-2182
Practice Address - Street 1:11209 N TATUM BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3092
Practice Address - Country:US
Practice Address - Phone:480-285-2180
Practice Address - Fax:480-285-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4490207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty