Provider Demographics
NPI:1275749178
Name:KHANDHERIA, PRIYAMVADA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYAMVADA
Middle Name:
Last Name:KHANDHERIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 50TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2549
Mailing Address - Country:US
Mailing Address - Phone:806-795-2533
Mailing Address - Fax:806-795-0336
Practice Address - Street 1:2424 50TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2549
Practice Address - Country:US
Practice Address - Phone:806-795-2533
Practice Address - Fax:806-795-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG43252084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine