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General NPI Number Information
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NPI Number | 1861945818
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Entity Type | Individual
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Provider Name | SRI RAGHAV SISTA M.D.,M.S
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Gender | Male
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 13400 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5499
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Country | US
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Telephone | 713-500-8935
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Fax |
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Provider Business Mailing Address
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Address Line | 13400 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5499
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | T5036
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 67346
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 69526
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | T5036
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License Number State | TX
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