Healthcare Provider Details

I. General information

NPI: 1639418247
Provider Name (Legal Business Name): SANDHYA VENUGOPAL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 229
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

3677 E ADOBE DR
PHOENIX AZ
85050-8333
US

V. Phone/Fax

Practice location:
  • Phone: 602-667-4657
  • Fax: 888-842-7006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDHYA VENUGOPAL
Title or Position: OWNER
Credential: MD
Phone: 520-444-8854