Provider Demographics
NPI:1114362985
Name:AMADO MEDINA, SANDRA MILENA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:AMADO MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MILENA
Other - Last Name:AMADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26077 NELSON WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6677
Mailing Address - Country:US
Mailing Address - Phone:832-228-2005
Mailing Address - Fax:
Practice Address - Street 1:26077 NELSON WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5642
Practice Address - Country:US
Practice Address - Phone:832-882-5632
Practice Address - Fax:832-553-2686
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5141207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX356715802Medicaid
TX477398ZHUBMedicare PIN