Provider Demographics
NPI:1558767558
Name:ANAMAYA INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ANAMAYA INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYTHILI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VEDALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-255-4900
Mailing Address - Street 1:54 W DOUBLE GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1098
Mailing Address - Country:US
Mailing Address - Phone:281-255-4900
Mailing Address - Fax:281-255-4901
Practice Address - Street 1:25420 KUYKENDAHL RD
Practice Address - Street 2:STE D1000
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-0000
Practice Address - Country:US
Practice Address - Phone:281-255-4900
Practice Address - Fax:281-255-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty