Healthcare Provider Details

I. General information

NPI: 1437827615
Provider Name (Legal Business Name): MATTHEW SALVATORE KALDAWI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 100
PHOENIX AZ
85027-3602
US

IV. Provider business mailing address

9401 W THUNDERBIRD RD STE 180
PEORIA AZ
85381-4210
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-516-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: