Healthcare Provider Details

I. General information

NPI: 1225344054
Provider Name (Legal Business Name): DHANASHREE ABHIJIT RAJDERKAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DHANASHREE SUBHASCHANDRA DANDE DMRD,DNB

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 12/11/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

IV. Provider business mailing address

902 SW 88TH ST
GAINESVILLE FL
32607-4942
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-8440
  • Fax:
Mailing address:
  • Phone: 314-971-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME118727
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number2010008607
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU7935
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberU7935
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number2010008607
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberME118727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: