Healthcare Provider Details

I. General information

NPI: 1457049298
Provider Name (Legal Business Name): MAKIYA SADO BADADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S LAKESHORE DR
TEMPE AZ
85282-7155
US

IV. Provider business mailing address

4801 S LAKESHORE DR STE 206
TEMPE AZ
85282-7157
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-9299
  • Fax:
Mailing address:
  • Phone: 480-504-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: