Healthcare Provider Details

I. General information

NPI: 1508788704
Provider Name (Legal Business Name): BIOHACK HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 W KELTON LN BLDG C1, STE 101
PEORIA AZ
85382-5001
US

IV. Provider business mailing address

8765 W KELTON LN BLDG C1, STE 101
PEORIA AZ
85382-5001
US

V. Phone/Fax

Practice location:
  • Phone: 904-228-6999
  • Fax:
Mailing address:
  • Phone: 904-228-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PRITI SINGH
Title or Position: MANAGER
Credential: MD
Phone: 904-228-6999