Healthcare Provider Details

I. General information

NPI: 1588303713
Provider Name (Legal Business Name): SWATHI MUDDASANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N LOOP 336 W STE A
CONROE TX
77301-1156
US

IV. Provider business mailing address

1120 N LOOP 336 W STE A
CONROE TX
77301-1156
US

V. Phone/Fax

Practice location:
  • Phone: 346-646-4220
  • Fax: 713-461-5307
Mailing address:
  • Phone: 346-646-4220
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116038162
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW3286
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020017680
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: