Provider Demographics
NPI:1417078999
Name:PANDYA, AVNI BANSI (MD)
Entity Type:Individual
Prefix:
First Name:AVNI
Middle Name:BANSI
Last Name:PANDYA
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 1:11401 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:314-359-4691
Mailing Address - Fax:
Practice Address - Street 1:11401 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:706-721-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00039201207Q00000X
AZ60628207Q00000X
CAA117083207Q00000X
CO0000609207Q00000X
CT054688207Q00000X
DEC1-0011698207Q00000X
FLME125196207Q00000X
IL036151557207Q00000X
IN01075598A207Q00000X
KS04-40105207Q00000X
KY49788207Q00000X
LA322039207Q00000X
MEMD20710207Q00000X
MDD79972207Q00000X
GA059488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine