Healthcare Provider Details

I. General information

NPI: 1427712983
Provider Name (Legal Business Name): KAELYN ZAKRAJSEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date: 03/30/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4879
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4879
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-6211
  • Fax:
Mailing address:
  • Phone: 401-444-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number9171
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: