Provider Demographics
NPI:1649802828
Name:DESERT SANDS MEDICAL GROUP
Entity type:Organization
Organization Name:DESERT SANDS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-648-5217
Mailing Address - Street 1:34406 N 27TH DR STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6079
Mailing Address - Country:US
Mailing Address - Phone:480-648-5217
Mailing Address - Fax:623-321-2352
Practice Address - Street 1:34406 N 27TH DR STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6079
Practice Address - Country:US
Practice Address - Phone:480-648-5217
Practice Address - Fax:623-321-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty