Provider Demographics
NPI:1700438082
Name:RAJENDRAN, KANCHANA
Entity Type:Individual
Prefix:MRS
First Name:KANCHANA
Middle Name:
Last Name:RAJENDRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 SEASHELL LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4857
Mailing Address - Country:US
Mailing Address - Phone:203-564-0500
Mailing Address - Fax:
Practice Address - Street 1:5009 SEASHELL LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4857
Practice Address - Country:US
Practice Address - Phone:203-564-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141669363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care