Provider Demographics
NPI:1952473589
Name:VASAVADA, NISHENDU M (MD)
Entity Type:Individual
Prefix:
First Name:NISHENDU
Middle Name:M
Last Name:VASAVADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FAIRWAY DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-221-1741
Mailing Address - Fax:972-939-2822
Practice Address - Street 1:4100 FAIRWAY DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-221-1741
Practice Address - Fax:972-939-2822
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF24902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034857502Medicaid
TX034857501Medicaid
OK200105580AMedicaid
TXTXB113678Medicare PIN
OK200105580AMedicaid
TX034857502Medicaid