Provider Demographics
NPI:1801852025
Name:BYSANI, NANDA (MD)
Entity type:Individual
Prefix:
First Name:NANDA
Middle Name:
Last Name:BYSANI
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 1:710 E PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4958
Mailing Address - Country:US
Mailing Address - Phone:972-262-8211
Mailing Address - Fax:972-262-8311
Practice Address - Street 1:710 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4958
Practice Address - Country:US
Practice Address - Phone:972-262-8211
Practice Address - Fax:972-262-8311
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7783208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220142803Medicaid
TX220142802Medicaid
TX220142801Medicaid
TXP00915323OtherRAILROAD MEDICARE
TX220142802Medicaid
TX220142801Medicaid
TX220142801Medicaid