Provider Demographics
NPI:1982658191
Name:SEDANI, SIMRAN (MD)
Entity Type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:SEDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATA
Other - Middle Name:N
Other - Last Name:CHANDIRAMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:810 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-201-8000
Practice Address - Fax:830-201-8008
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07994100207R00000X
TXS1505208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30059867OtherKEYSTONE MERCY
PA3706659000OtherKEYSTONE HEALTH PLAN EAST
NJ0140261Medicaid
PA102332343 0001Medicaid
NJP00850701OtherRR MEDICARE
NJ0140261Medicaid
NJ102156R2YMedicare ID - Type Unspecified
NJ102159XPFMedicare PIN
PA146447ZDKTMedicare PIN
PA146447ZCHMMedicare PIN