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General NPI Number Information
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NPI Number | 1780406983
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Entity Type | Organization
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Legal Business Name | SPARK HEALING AZ PLLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 14506 W GRANITE VALLEY DR STE 225
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-6013
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Country | US
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Telephone | 888-616-5912
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Fax | 888-616-5913
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Provider Business Mailing Address
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Address Line | 14506 W GRANITE VALLEY DR STE 225
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-6013
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Country | US
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Telephone | 888-616-5912
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Fax | 888-616-5913
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. SUSHIL PANDEY
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Credential | MD
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Telephone | 347-239-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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