Provider Demographics
NPI:1770720112
Name:NAGAMANI, SANDESH SREENATH (MD)
Entity type:Individual
Prefix:
First Name:SANDESH
Middle Name:SREENATH
Last Name:NAGAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANDESH
Other - Middle Name:CHAKRAVARTHY
Other - Last Name:SANDESH NAGAMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 GREENWAY PLZ
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1903207SG0201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L7307Medicare PIN
TX8L27499Medicare PIN
TX8L7945Medicare PIN
TXTXB104170Medicare PIN