Individual
ELAINE M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10210 N 92ND ST, SUITE 207, SCOTTSDALE, AZ 85258-4509
(480) 661-1332
(480) 661-1364
Mailing address
4722 N 24TH ST, STE 150, PHOENIX, AZ 85016-4800
(602) 256-4628
(602) 957-9438
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
33938
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
953142
—
AZ
Enumeration date
04/10/2006
Last updated
08/25/2010
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