Healthcare Provider Details

I. General information

NPI: 1154082576
Provider Name (Legal Business Name): AASHAY PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 W THUNDERBIRD RD STE F101
GLENDALE AZ
85306-3723
US

IV. Provider business mailing address

6677 W THUNDERBIRD RD STE F101
GLENDALE AZ
85306-3723
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-3939
  • Fax: 480-393-5144
Mailing address:
  • Phone: 623-878-3939
  • Fax: 480-393-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number79336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: