Healthcare Provider Details

I. General information

NPI: 1669393476
Provider Name (Legal Business Name): BRUNO SUBBARAO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 W MCDOWELL RD
AVONDALE AZ
85392-5240
US

IV. Provider business mailing address

1717 E MORTEN AVE UNIT 36
PHOENIX AZ
85020-4756
US

V. Phone/Fax

Practice location:
  • Phone: 623-404-4417
  • Fax: 623-404-4416
Mailing address:
  • Phone: 412-478-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUNO SHANKAR SUBBARAO
Title or Position: OWNER
Credential: DO
Phone: 412-478-9148