Provider Demographics
NPI:1922186659
Name:IYENGAR, PHANIRAJ (MD)
Entity type:Individual
Prefix:
First Name:PHANIRAJ
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY STE 765
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2246
Mailing Address - Country:US
Mailing Address - Phone:702-731-8115
Mailing Address - Fax:702-784-7844
Practice Address - Street 1:345 23RD AVE N STE 212
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-342-6840
Practice Address - Fax:615-329-4469
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0453182084V0102X
CAA564692084N0400X
TN679752084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology