| Spark Healing Az Pllc | |
|
14506 W Granite Valley Dr Ste 225 Sun City West AZ 85375-6013 | |
| (888) 616-5912 | |
| (888) 616-5913 |
| Full Name | Spark Healing Az Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 14506 W Granite Valley Dr Ste 225, Sun City West, Arizona |
| Authorized Official Name and Position | Sushil Pandey (MEMBER MANAGER) |
| Authorized Official Contact | 3472396581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Healing Az Pllc 14506 W Granite Valley Dr Ste 225 Sun City West AZ 85375-6013 Ph: (888) 616-5912 | Spark Healing Az Pllc 14506 W Granite Valley Dr Ste 225 Sun City West AZ 85375-6013 Ph: (888) 616-5912 |
| NPI Number | 1780406983 |
|---|---|
| Provider Enumeration Date | 10/29/2024 |
| Last Update Date | 09/01/2025 |
| Medicare PECOS PAC ID | 7618406463 |
|---|---|
| Medicare Enrollment ID | O20250123003751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780406983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Sushil R Pandey |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1568788099 PECOS PAC ID: 7416072848 Enrollment ID: I20100908001152 |
| Provider Name | Raghad Musa Salame Batarseh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710794599 PECOS PAC ID: 7618406166 Enrollment ID: I20250128004170 |
| Provider Name | Pei Hsin Hsu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831909068 PECOS PAC ID: 1951830223 Enrollment ID: I20250131000254 |
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