Provider Demographics
NPI:1982362166
Name:SA PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SA PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:928-916-7860
Mailing Address - Street 1:12725 N PORTER CAMP TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-4406
Mailing Address - Country:US
Mailing Address - Phone:928-916-7860
Mailing Address - Fax:928-436-2078
Practice Address - Street 1:12725 N PORTER CAMP TRL
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-4406
Practice Address - Country:US
Practice Address - Phone:928-916-7860
Practice Address - Fax:928-436-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty