Provider Demographics
NPI:1265500227
Name:KANDALA, NANDINI R (MD)
Entity Type:Individual
Prefix:
First Name:NANDINI
Middle Name:R
Last Name:KANDALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-686-0207
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:123 ED SCHMIDT BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5585
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-846-2072
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036111336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0214601OtherDPS
TXBR9039315OtherDEA