MEDICARE: DR. SANDHYA VENUGOPAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	AZ34956	AZ
2	208M00000X	Hospitalist Physician	34956	AZ
3	207R00000X	Internal Medicine Physician	34956	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z203329	OTHER	AZ	MEDICARE PTAN- GROUP
2	Z109127	OTHER	AZ	MEDICARE-TYPE UNSPECIFIED
3	Z109128	OTHER	AZ	MEDICARE-TYPE UNSPECIFIED
6	P00341403	OTHER	AZ	RR MEDICARE
7	Z204992	OTHER	AZ	MEDICARE PTAN- INDIVIDUAL
8	Z109129	OTHER	AZ	MEDICARE-TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	AZ0423230	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1730115338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDHYA VENUGOPAL MD

Provider Business Mailing Address
First Line	:	3677 E ADOBE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-8333
Country	:	US
Telephone Number	:	480-695-3064
Fax Number	:	800-854-6704

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST STE 229 (OLD 216)
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	602-667-4657
Fax Number	:	888-842-7006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/12/2025

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Directions to “ DR. SANDHYA VENUGOPAL MD” Practice Location

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