Provider Demographics
NPI:1205813730
Name:WALDROP, MYLYNDA CASUNDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLYNDA
Middle Name:CASUNDRA
Last Name:WALDROP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYNDA
Other - Middle Name:CASUNDRA
Other - Last Name:WALDROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2400 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5378
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-901-3937
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-901-3937
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159202402Medicaid
TX159202402Medicaid
TXTXB136926Medicare PIN