Provider Demographics
NPI:1669141719
Name:ACANDA, MAYLY (PA)
Entity type:Individual
Prefix:
First Name:MAYLY
Middle Name:
Last Name:ACANDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NORTH LOOP W STE 900
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4716
Mailing Address - Country:US
Mailing Address - Phone:832-930-1202
Mailing Address - Fax:832-304-6385
Practice Address - Street 1:1111 NORTH LOOP W STE 900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4716
Practice Address - Country:US
Practice Address - Phone:832-930-1202
Practice Address - Fax:832-304-6385
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant