Provider Demographics
NPI:1720344096
Name:ROUSKU, MADELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:
Last Name:ROUSKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MADELYN
Other - Middle Name:
Other - Last Name:PEREZ AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9135 N 106TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-6109
Mailing Address - Country:US
Mailing Address - Phone:786-537-9346
Mailing Address - Fax:
Practice Address - Street 1:9135 N 106TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-6109
Practice Address - Country:US
Practice Address - Phone:786-537-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND141662084P0800X
AZ530172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry