Healthcare Provider Details

I. General information

NPI: 1689134702
Provider Name (Legal Business Name): SRIVYSHNAVI NARRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 09/06/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13041 N. DEL WEBB BLVD STE 200
SUN CITY AZ
85351
US

IV. Provider business mailing address

13041 N. DEL WEBB BLVD STE 200
SUN CITY AZ
85351
US

V. Phone/Fax

Practice location:
  • Phone: 623-832-0300
  • Fax: 623-285-2801
Mailing address:
  • Phone: 623-832-0300
  • Fax: 623-285-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number72477
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: