Healthcare Provider Details

I. General information

NPI: 1558618645
Provider Name (Legal Business Name): PAMELA S. HENDERSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 E SHEA BLVD STE 105
SCOTTSDALE AZ
85260-6411
US

IV. Provider business mailing address

7425 E SHEA BLVD STE 105
SCOTTSDALE AZ
85260-6411
US

V. Phone/Fax

Practice location:
  • Phone: 480-596-6886
  • Fax: 480-596-8989
Mailing address:
  • Phone: 480-596-6886
  • Fax: 480-596-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number22689
License Number StateAZ

VIII. Authorized Official

Name: DR. PAMELA S HENDERSON
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 480-596-6886