Healthcare Provider Details

I. General information

NPI: 1063353282
Provider Name (Legal Business Name): SYDNEY BASTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 S POWER RD STE 252
MESA AZ
85206-3700
US

IV. Provider business mailing address

2255 S BAHAMA DR
GILBERT AZ
85295-5634
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-6185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-22674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: