Healthcare Provider Details

I. General information

NPI: 1790668085
Provider Name (Legal Business Name): LONGEVITY NEUROLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 N FRANK LLOYD WRIGHT BLVD STE 1340
SCOTTSDALE AZ
85260-8878
US

IV. Provider business mailing address

13238 N 79TH ST
SCOTTSDALE AZ
85260-4016
US

V. Phone/Fax

Practice location:
  • Phone: 480-770-0427
  • Fax: 480-770-0428
Mailing address:
  • Phone: 336-624-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TASHA POWELL
Title or Position: OWNER
Credential: MD
Phone: 480-770-0427