Healthcare Provider Details

I. General information

NPI: 1639388689
Provider Name (Legal Business Name): MEERA SHREEDHARA VASUDHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 JOE RAMSEY BLVD E
GREENVILLE TX
75401-7852
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 903-408-5112
  • Fax: 903-408-5124
Mailing address:
  • Phone: 972-997-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberM5507
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM5507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: