Healthcare Provider Details

I. General information

NPI: 1518652239
Provider Name (Legal Business Name): PEDIATRIC DEVELOPMENTAL CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21805 S ELLSWORTH RD STE 111
QUEEN CREEK AZ
85142-9366
US

IV. Provider business mailing address

3281 E CEDAR DR
CHANDLER AZ
85249-4509
US

V. Phone/Fax

Practice location:
  • Phone: 480-462-3868
  • Fax: 480-462-3868
Mailing address:
  • Phone: 602-751-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NILAM PATEL KHURANA
Title or Position: OWNER
Credential: MD
Phone: 602-751-7023