MEDICARE: STEFFY KANDATHIL

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	363LF0000X	Family Nurse Practitioner	AP131450	TX

General Provider Information

NPI Number	:	1578012597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFFY KANDATHIL

Provider Business Mailing Address
First Line	:	3230 S DAIRY ASHFORD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 S DAIRY ASHFORD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2319
Country	:	US
Telephone Number	:	281-558-1338
Fax Number	:

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

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/03/2016

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Directions to “ STEFFY KANDATHIL ” Practice Location

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