Healthcare Provider Details

I. General information

NPI: 1427439876
Provider Name (Legal Business Name): VISHNU ANAND CUDDAPAH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

IV. Provider business mailing address

1250 MOURSUND ST
HOUSTON TX
77030-3410
US

V. Phone/Fax

Practice location:
  • Phone: 328-822-0390
  • Fax:
Mailing address:
  • Phone: 328-822-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT209607
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMT209607
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberV3577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: