| Blue Sky Health | |
|
407 N Cedar Ridge Dr #320 Duncanville TX 75116-3197 | |
| (972) 709-7556 | |
| (972) 709-7611 |
| Full Name | Blue Sky Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 407 N Cedar Ridge Dr, Duncanville, Texas |
| Authorized Official Name and Position | Shahzad Allawala (CFO) |
| Authorized Official Contact | 9707097556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Sky Health P.o. Box 687 Desoto TX 75123 Ph: (972) 709-7556 | Blue Sky Health 407 N Cedar Ridge Dr #320 Duncanville TX 75116-3197 Ph: (972) 709-7556 |
| NPI Number | 1003135831 |
|---|---|
| Provider Enumeration Date | 05/18/2010 |
| Last Update Date | 03/20/2013 |
| Medicare PECOS PAC ID | 2466576046 |
|---|---|
| Medicare Enrollment ID | O20100903000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003135831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | M9791 (Texas) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | M9791 (Texas) | Secondary |
| Provider Name | Shahzad S Allawala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861498743 PECOS PAC ID: 3779510623 Enrollment ID: I20100909000580 |
| Provider Name | Dominique R Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295019909 PECOS PAC ID: 9133380223 Enrollment ID: I20120417000586 |
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