=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164954756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIRA PANDYA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2017
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7301 E 2ND ST STE 310
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-821-4657
-----------------------------------------------------
Fax | 866-207-6786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7301 E 2ND ST STE 310
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-821-4657
-----------------------------------------------------
Fax | 866-207-6786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | POD000987
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------