Provider Demographics
NPI:1730115338
Name:VENUGOPAL, SANDHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:
Last Name:VENUGOPAL
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 1:3677 E ADOBE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8333
Mailing Address - Country:US
Mailing Address - Phone:480-695-3064
Mailing Address - Fax:800-854-6704
Practice Address - Street 1:16601 N 40TH ST STE 229 (OLD 216)
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3354
Practice Address - Country:US
Practice Address - Phone:602-667-4657
Practice Address - Fax:888-842-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ34956207R00000X
AZ34956208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ203329OtherMEDICARE PTAN- GROUP
AZZ109127OtherMEDICARE-TYPE UNSPECIFIED
AZZ109128OtherMEDICARE-TYPE UNSPECIFIED
AZ074540Medicaid
AZAZ0423230OtherBCBS
AZP00341403OtherRR MEDICARE
AZZ204992OtherMEDICARE PTAN- INDIVIDUAL
AZZ109129OtherMEDICARE-TYPE UNSPECIFIED