Healthcare Provider Details

I. General information

NPI: 1114581188
Provider Name (Legal Business Name): KELSIE SUE EFFREIN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 301
PHOENIX AZ
85027-4016
US

IV. Provider business mailing address

8899 E PALM TREE DR
SCOTTSDALE AZ
85255-9290
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-2700
  • Fax: 313-745-1520
Mailing address:
  • Phone: 515-444-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001050
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: