Provider Demographics
NPI:1578874368
Name:GAJENDRA, NISHA
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:GAJENDRA
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 1:2587 FM 423 STE 130
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6670
Mailing Address - Country:US
Mailing Address - Phone:972-200-4780
Mailing Address - Fax:844-363-2590
Practice Address - Street 1:2587 FM 423 STE 130
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068
Practice Address - Country:US
Practice Address - Phone:972-200-4780
Practice Address - Fax:844-363-2590
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine