Healthcare Provider Details

I. General information

NPI: 1396629176
Provider Name (Legal Business Name): SYNERGY WOUND 360 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 E DESERT COVE AVE # A103
SCOTTSDALE AZ
85260-6227
US

IV. Provider business mailing address

9070 E DESERT COVE AVE # A103
SCOTTSDALE AZ
85260-6227
US

V. Phone/Fax

Practice location:
  • Phone: 480-553-6168
  • Fax: 480-779-8905
Mailing address:
  • Phone: 480-553-6168
  • Fax: 480-779-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: VINAMRA JAIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 480-553-6168