Healthcare Provider Details

I. General information

NPI: 1871243428
Provider Name (Legal Business Name): STEPHANIE SPERRAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13657 W MCDOWELL RD STE 220
GOODYEAR AZ
85395-2603
US

IV. Provider business mailing address

15509 N SCOTTSDALE RD UNIT 2008
SCOTTSDALE AZ
85254-3125
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-5609
  • Fax:
Mailing address:
  • Phone: 561-685-1972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number011739
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: