Provider Demographics
NPI:1891088563
Name:AMMUNJE, ASHWINI NAYAK (MD)
Entity Type:Individual
Prefix:
First Name:ASHWINI
Middle Name:NAYAK
Last Name:AMMUNJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHWINI
Other - Middle Name:NAYAK
Other - Last Name:AMMUNJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8765 W KELTON LANE UNIT B1
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3584
Mailing Address - Country:US
Mailing Address - Phone:623-670-7772
Mailing Address - Fax:623-444-2361
Practice Address - Street 1:8765 W KELTON LN UNIT B1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3584
Practice Address - Country:US
Practice Address - Phone:623-670-7772
Practice Address - Fax:623-444-2361
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48269207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ196566OtherMEDICARE PTAN
AZ943914Medicaid