Provider Demographics
NPI:1184831976
Name:PRATAP, RAJU
Entity type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:PRATAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 REGAL SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4585
Mailing Address - Country:US
Mailing Address - Phone:832-938-2736
Mailing Address - Fax:
Practice Address - Street 1:4619 REGAL SHADOW LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4585
Practice Address - Country:US
Practice Address - Phone:832-938-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1506231H00000X
TX80482231H00000X
TNTN1807235Z00000X
TX107709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist