Healthcare Provider Details

I. General information

NPI: 1336431907
Provider Name (Legal Business Name): VITALIY ZHIVOTENKO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N SCOTTSDALE RD STE I-100A
PARADISE VALLEY AZ
85253-5927
US

IV. Provider business mailing address

5410 N SCOTTSDALE RD STE I-100A
PARADISE VALLEY AZ
85253-5927
US

V. Phone/Fax

Practice location:
  • Phone: 480-572-2444
  • Fax: 602-581-7158
Mailing address:
  • Phone: 480-572-2444
  • Fax: 602-581-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number282150
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number282150
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number008793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: