Healthcare Provider Details

I. General information

NPI: 1003771833
Provider Name (Legal Business Name): ELITE INTEGRATIVE GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 W THUNDERBIRD RD # 202
GLENDALE AZ
85306-4700
US

IV. Provider business mailing address

5422 W THUNDERBIRD RD # 202
GLENDALE AZ
85306-4700
US

V. Phone/Fax

Practice location:
  • Phone: 646-752-4685
  • Fax:
Mailing address:
  • Phone: 646-752-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELA SUYUNOVA
Title or Position: OWNER
Credential:
Phone: 646-752-4685