Healthcare Provider Details

I. General information

NPI: 1518991223
Provider Name (Legal Business Name): SUMEET K MENDONCA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 S ROME ST
GILBERT AZ
85297-7341
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 480-890-7705
  • Fax: 480-398-8095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number40326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: