Healthcare Provider Details

I. General information

NPI: 1255815072
Provider Name (Legal Business Name): SEEMA PANDYA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY STE 230
DALLAS TX
75231-6079
US

IV. Provider business mailing address

3930 MCKINNEY AVE APT 359
DALLAS TX
75204-2063
US

V. Phone/Fax

Practice location:
  • Phone: 215-818-5765
  • Fax: 214-818-5782
Mailing address:
  • Phone: 512-779-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number37984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: