Provider Demographics
NPI:1740515543
Name:ANDRADE-FEGALI, YOHANNA (MD)
Entity type:Individual
Prefix:
First Name:YOHANNA
Middle Name:
Last Name:ANDRADE-FEGALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 W NORTHWEST HWY STE 170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4783
Mailing Address - Country:US
Mailing Address - Phone:214-654-0007
Mailing Address - Fax:214-654-9272
Practice Address - Street 1:2750 W NORTHWEST HWY STE 170
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4783
Practice Address - Country:US
Practice Address - Phone:214-654-0007
Practice Address - Fax:214-654-9272
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4909208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211852301Medicaid