Healthcare Provider Details

I. General information

NPI: 1154995223
Provider Name (Legal Business Name): ASHAY VAIDYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E WARNER RD
GILBERT AZ
85296-3082
US

IV. Provider business mailing address

155 E WARNER RD
GILBERT AZ
85296-3082
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-6600
  • Fax: 480-649-6700
Mailing address:
  • Phone: 480-649-6600
  • Fax: 480-649-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number76831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: