Healthcare Provider Details

I. General information

NPI: 1871887828
Provider Name (Legal Business Name): EAST VALLEY DIABETES & ENDOCRINOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 130
GILBERT AZ
85297-1506
US

IV. Provider business mailing address

4100 S LINDSAY RD STE 130
GILBERT AZ
85297-1506
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-9531
  • Fax: 480-782-9530
Mailing address:
  • Phone: 480-782-9531
  • Fax: 480-782-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number44679
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVENDRA G WADWEKAR
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 480-782-9531