Healthcare Provider Details

I. General information

NPI: 1134326796
Provider Name (Legal Business Name): ANURANJITA NAYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

IV. Provider business mailing address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-1750
  • Fax:
Mailing address:
  • Phone: 832-822-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 107734
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME107734
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberQ1461
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberQ1461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: