Provider Demographics
NPI:1447800628
Name:MADANI, LAILEE
Entity Type:Individual
Prefix:
First Name:LAILEE
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14103 SHERBURN MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8172
Mailing Address - Country:US
Mailing Address - Phone:832-515-3941
Mailing Address - Fax:
Practice Address - Street 1:2615 SOUTHWEST FWY STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4611
Practice Address - Country:US
Practice Address - Phone:713-523-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty