Provider Demographics
NPI:1407548845
Name:ZADAKIS, MICHAEL JOHN (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:ZADAKIS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 E BASELINE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2743
Mailing Address - Country:US
Mailing Address - Phone:480-565-6440
Mailing Address - Fax:480-454-1085
Practice Address - Street 1:15300 N 90TH ST STE 750
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2776
Practice Address - Country:US
Practice Address - Phone:480-565-6440
Practice Address - Fax:480-454-1085
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ292205363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health