Provider Demographics
NPI:1659683878
Name:BURNSIDE, SCOTT G (NPP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:G
Last Name:BURNSIDE
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
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Mailing Address - Street 1:1642 S PRIEST DR
Mailing Address - Street 2:BLDG. 6, SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6204
Mailing Address - Country:US
Mailing Address - Phone:480-929-5100
Mailing Address - Fax:480-731-1066
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:602-302-7715
Practice Address - Fax:602-302-6973
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2015-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY574003-1163W00000X
NY401296363LP0808X
AZAP8253363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse