Provider Demographics
NPI:1619185519
Name:KOMMANA, SANDHYA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:L
Last Name:KOMMANA
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 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:682-207-1030
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2228
Practice Address - Country:US
Practice Address - Phone:817-877-5858
Practice Address - Fax:817-335-4418
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41649208M00000X, 207R00000X
TXR2900207RN0300X, 207R00000X
WAMD61136677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000569234OtherANTHEM
IN200903590Medicaid
KY3525755000OtherPASSPORT ADVANTAGE
KY50019467OtherPASSPORT
TX381147301Medicaid
KY7100042940Medicaid
KY50033376OtherPASSPORT/PASSPORT ADVANTAGE
KY7100042940Medicaid
KYK020830Medicare PIN