Healthcare Provider Details

I. General information

NPI: 1043840606
Provider Name (Legal Business Name): FRANK AGYEPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date: 12/31/2024
Reactivation Date: 02/18/2025

III. Provider practice location address

2338 W ROYAL PALM RD STE J
PHOENIX AZ
85021-9339
US

IV. Provider business mailing address

1330 S POTOMAC ST SUITE 112
AURORA CO
80012-4527
US

V. Phone/Fax

Practice location:
  • Phone: 885-772-8847
  • Fax: 248-479-4431
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: