Provider Demographics
NPI:1164632345
Name:VARGHESE, SANDY SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:SAMUEL
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6163
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:7120 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8608
Practice Address - Country:US
Practice Address - Phone:817-347-8025
Practice Address - Fax:817-347-8001
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics