Provider Demographics
NPI:1740787043
Name:KANDASWAMY, PREETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:PREETHA
Middle Name:
Last Name:KANDASWAMY
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 1:6130 W PARKER RD STE 410
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7982
Mailing Address - Country:US
Mailing Address - Phone:469-303-8380
Mailing Address - Fax:469-303-0673
Practice Address - Street 1:6130 W PARKER RD STE 410
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7982
Practice Address - Country:US
Practice Address - Phone:469-303-8380
Practice Address - Fax:469-303-0673
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0823OtherLICENSE NUMBER