Provider Demographics
NPI:1710755731
Name:VICTOR, VANDHANA FREDY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:VANDHANA
Middle Name:FREDY
Last Name:VICTOR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21118 DOVER PARK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6150
Mailing Address - Country:US
Mailing Address - Phone:832-628-0381
Mailing Address - Fax:
Practice Address - Street 1:21118 DOVER PARK LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6150
Practice Address - Country:US
Practice Address - Phone:832-628-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant