| Shyamala, P.c. | |
|
6677 W Thunderbird Rd Ste D148 Glendale AZ 85306-3769 | |
| (602) 843-3811 | |
| (602) 843-0044 |
| Full Name | Shyamala, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6677 W Thunderbird Rd Ste D148, Glendale, Arizona |
| Authorized Official Name and Position | Shyamala Kumar (PRESIDENT) |
| Authorized Official Contact | 6028433811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shyamala, P.c. 6677 W Thunderbird Rd Ste D148 Glendale AZ 85306-3769 Ph: (602) 843-3811 | Shyamala, P.c. 6677 W Thunderbird Rd Ste D148 Glendale AZ 85306-3769 Ph: (602) 843-3811 |
| NPI Number | 1255514907 |
|---|---|
| Provider Enumeration Date | 12/17/2007 |
| Last Update Date | 11/16/2021 |
| Certification Date | 11/16/2021 |
| Medicare PECOS PAC ID | 4486639614 |
|---|---|
| Medicare Enrollment ID | O20040622000995 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255514907 | NPI | - | NPPES |
| 569353-03 | Medicaid | AZ | |
| Z74891 | Other | AZ | MDCR GROUP BOX 33B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 28250 (Arizona) | Primary |
| Provider Name | Shyamala Kumar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457314841 PECOS PAC ID: 3173783479 Enrollment ID: I20120323000278 |
| Provider Name | Sarah Yassin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194330266 PECOS PAC ID: 7810390465 Enrollment ID: I20210720003992 |
| Provider Name | Jennifer Heeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487114054 PECOS PAC ID: 2769876473 Enrollment ID: I20220223000963 |
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