Healthcare Provider Details

I. General information

NPI: 1871553529
Provider Name (Legal Business Name): AJAY NEILCHAND YEDDU I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AJAY NEILCHAND YEDDU

II. Dates (important events)

Enumeration Date: 03/26/2006
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 W GUADALUPE RD BUILDING 4 SUITE 125
GILBERT AZ
85233-3003
US

IV. Provider business mailing address

PO BOX 97
HIGLEY AZ
85236-0097
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-1914
  • Fax: 480-838-9434
Mailing address:
  • Phone: 480-838-1914
  • Fax: 480-838-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34866
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-15499R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34866
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: