MEDICARE: SANGEETA G ELHENCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	J9012	TX
2	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	J9012	TX

General Provider Information

NPI Number	:	1275538647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANGEETA G ELHENCE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 733784
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3784
Country	:	US
Telephone Number	:	682-885-6483
Fax Number	:	682-885-3113

Provider Business Practice Location Address
First Line	:	1300 W LANCASTER AVE STE 205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3490
Country	:	US
Telephone Number	:	817-336-8611
Fax Number	:	817-390-2981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/17/2023

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