Healthcare Provider Details

I. General information

NPI: 1538472766
Provider Name (Legal Business Name): MANDY STEPHANIE OLIDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-243-7277
  • Fax: 623-247-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: