Provider Demographics
NPI:1518200799
Name:DALELA, ANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:DALELA
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 1:706 MANCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8930
Mailing Address - Country:US
Mailing Address - Phone:347-413-2135
Mailing Address - Fax:
Practice Address - Street 1:4909 GOLDEN TRIANGLE BLVD STE 231
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4480
Practice Address - Country:US
Practice Address - Phone:682-297-5437
Practice Address - Fax:682-228-6447
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1010OtherTEXAS LICENSE