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General NPI Number Information
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NPI Number | 1003135831
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Entity Type | Organization
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Legal Business Name | BLUE SKY HEALTH
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 407 N CEDAR RIDGE DR #320
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3197
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Country | US
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Telephone | 972-709-7556
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Fax | 972-709-7611
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Provider Business Mailing Address
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Address Line | P.O. BOX 687
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City | DESOTO
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State | TX
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Zip | 75123
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Country | US
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Telephone | 972-709-7556
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Fax | 972-709-7611
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Authorized Official
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Title or Position | CFO
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Name | SHAHZAD ALLAWALA
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Credential | MD
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Telephone | 970-709-7556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M9791
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M9791
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License Number State | TX
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