Provider Demographics
NPI:1932292836
Name:JASANI, BIANCA SHAH (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:SHAH
Last Name:JASANI
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 1:9106 CROWN JEWEL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-9811
Mailing Address - Country:US
Mailing Address - Phone:832-541-5655
Mailing Address - Fax:
Practice Address - Street 1:8901 BOONE ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099
Practice Address - Country:US
Practice Address - Phone:281-454-0519
Practice Address - Fax:281-454-0806
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932292836Medicaid