Provider Demographics
NPI:1700869393
Name:RAJADHYAKSHA, SANDEEPA SHIRODKAR (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEPA
Middle Name:SHIRODKAR
Last Name:RAJADHYAKSHA
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:5757 WARREN PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4287
Practice Address - Country:US
Practice Address - Phone:469-498-6300
Practice Address - Fax:972-542-2801
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200982103Medicaid
TX200982101Medicaid