Provider Demographics
NPI:1124137591
Name:ANISHA WAXALI MD PA
Entity type:Organization
Organization Name:ANISHA WAXALI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WAXALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-491-0094
Mailing Address - Street 1:4780 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3162
Mailing Address - Country:US
Mailing Address - Phone:281-491-0094
Mailing Address - Fax:281-491-0111
Practice Address - Street 1:4780 SWEETWATER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3162
Practice Address - Country:US
Practice Address - Phone:281-491-0094
Practice Address - Fax:281-491-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37053802Medicaid
TX37053802Medicaid