MEDICARE: VAISHNAVI NEDUNOORI NP

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	363L00000X	Nurse Practitioner	1217970	TX

General Provider Information

NPI Number	:	1861102048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAISHNAVI NEDUNOORI NP

Provider Business Mailing Address
First Line	:	457 MOONLIGHT WAY
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-6704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	457 MOONLIGHT WAY
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-6704
Country	:	US
Telephone Number	:	770-378-9285
Fax Number	:

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

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	12/08/2025

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