Provider Demographics
NPI:1215730494
Name:SURGICAL ALLY, LLC
Entity type:Organization
Organization Name:SURGICAL ALLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:602-918-4351
Mailing Address - Street 1:16193 W DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5749
Mailing Address - Country:US
Mailing Address - Phone:602-918-4351
Mailing Address - Fax:
Practice Address - Street 1:16193 W DAVIS RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5749
Practice Address - Country:US
Practice Address - Phone:602-918-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty