MEDICARE: MR. SHAIK VAVANAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		AZ

General Provider Information

NPI Number	:	1649151812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAIK VAVANAM

Provider Business Mailing Address
First Line	:	4225 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7475
Country	:	US
Telephone Number	:	602-869-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 E MCDOWELL RD
Second Line	:	APPT 2057
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7475
Country	:	US
Telephone Number	:	602-869-0785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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Directions to “ MR. SHAIK VAVANAM ” Practice Location

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