Provider Demographics
NPI:1023213063
Name:GANDHI, SHYAMA (MD)
Entity Type:Individual
Prefix:
First Name:SHYAMA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5047
Mailing Address - Country:US
Mailing Address - Phone:214-750-5100
Mailing Address - Fax:214-750-4500
Practice Address - Street 1:4235 W NORTHWEST HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5047
Practice Address - Country:US
Practice Address - Phone:214-750-5100
Practice Address - Fax:214-750-4500
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X0099OtherBLUE CROSS BLUE SHIELD
TX8X0099OtherBLUE CROSS BLUE SHIELD