MRS. SAMURDHI JAYAWEERA ROBERTS (NPI# 1467774042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467774042 |
| Entity Type | Individual |
| Full Name | MRS. SAMURDHI JAYAWEERA ROBERTS |
| Credential | PA-C |
| Practice Address |
409 S 104th Ave Tolleson AZ 85353-9236 |
| Practice Telephone | 6239071846 |
| Mailing Telephone | 6239071846 |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2020-06-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
7786 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
409 S 104TH AVE |
| City | TOLLESON |
| State | AZ |
| Zip Code | 85353-9236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710503388 | Annie's Home, LLC | Home Health | 8517 W Chickasaw St., Tolleson, AZ 85353 | 2020-06-19 |
| 1427614429 | Destiny Behavioral Health Residential Care LLC 6 | Community Based Residential Treatment Facility, Mental Illness | 8755 W Pioneer Street, Tolleson, AZ 85353 | 2019-05-15 |
| 1831669258 | New Beginning Behavioral Health LLC | Psychiatric Residential Treatment Facility | 3329 S 87th Dr, Tolleson, AZ 85353 | 2018-11-28 |
| 1679049886 | Jaclyn Peters | Registered Nurse | 9401 West Garfield Street, Tolleson, AZ 85353 | 2018-10-16 |
| 1265949861 | Destiny Behavioral Health Residential Care LLC 5 | Community Based Residential Treatment Facility, Mental Illness | 10313 W Hess Street, Tolleson, AZ 85353 | 2018-01-04 |
| 1174858260 | Earl Dean Elwood | Pharmacist | 500 S. 99th Ave, Tolleson, AZ 85353 | 2009-10-07 |
| 1952533556 | Sun Valley Pharmacy LLC | Pharmacy | 219 W Pima, Gila Bend, AZ 85353 | 2009-08-14 |
| 1467570747 | Union Elementary School | Local Education Agency (LEA) | 3834 S 91st Ave, Tolleson, AZ 85353 | 2007-03-26 |
| 1285798462 | Promenade Dental Group, LLP | Dentist | 2755 S 99th Ave, Ste 105, Tolleson, AZ 85353 | 2006-12-21 |
| 1679636781 | Greta Denise Doss | Respite Care | 3006 S 102 Ln, Tolleson, AZ 85353 | 2006-12-19 |
| Find all providers in zip 85353 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659821262 | U.S. Healthworks Medical Group of Arizona, Inc. | Preventive Medicine | 2301 N Forbes Blvd, Tucson, AZ 85745-1455 | 2016-10-06 |
| 1154728954 | Healthstat On-site Clinic Polsinelli Phoenix Az | Preventive Medicine | One East Way Washington, Suite 1200, Phoenix, AZ 85004 | 2014-11-24 |
| 1295038990 | James Louis Schamadan | Preventive Medicine | 24350 N Whispering Ridge Way, Unit 49, Scottsdale, AZ 85255-5728 | 2010-12-19 |
| 1982934881 | Philip G Glennie | Preventive Medicine | 888 S Craycroft Rd Ste 150, Tucson, AZ 85711-7177 | 2009-12-28 |
| 1053548081 | Andrew Chad Yorgason | Preventive Medicine | 5801 S Wintersburg Rd, Tonopah, AZ 85354-7529 | 2009-06-17 |
| 1275670242 | Keith David Mosienko | Preventive Medicine | 6865 W Briles Rd, Peoria, AZ 85383-7015 | 2007-01-31 |
| 1891880829 | Thomas M Ronan | Preventive Medicine | 4730 E Indian School Rd Ste 211, Phoenix, AZ 85018-5410 | 2006-10-04 |
| 1932117041 | Robert Lewis Levitin | Preventive Medicine | 15150 N Hayden Rd Ste 110, Scottsdale, AZ 85260-2514 | 2006-08-04 |
| 1053861658 | U.S. Healthworks Medical Group of Arizona, Inc. | Preventive Medicine | 1626 S Priest Dr, Suite 101, Tempe, AZ 85281-6204 | 2016-10-06 |
| 1093265696 | U.S. Healthworks Medical Group of Arizona, Inc. | Preventive Medicine | 10335 N Scottsdale Rd, Scottsdale, AZ 85253-1435 | 2016-10-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.