Provider Demographics
NPI:1275532095
Name:EMANDI, SANJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:K
Last Name:EMANDI
Suffix:
Gender:M
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:3550 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5004
Practice Address - Country:US
Practice Address - Phone:903-785-0031
Practice Address - Fax:972-784-6755
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME874892085R0001X
TXQ99902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01794670OtherRAILROAD
FL267645100Medicaid
OK200681210AOtherOKLAHOMA MEDICAID
TX362377901Medicaid
FL267645100Medicaid
TX525742YKYCMedicare PIN