Healthcare Provider Details

I. General information

NPI: 1942565403
Provider Name (Legal Business Name): SOWMYA NANJAPPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 15TH ST STE 110
PLANO TX
75093-5826
US

IV. Provider business mailing address

4100 W 15TH ST STE 110
PLANO TX
75093-5826
US

V. Phone/Fax

Practice location:
  • Phone: 469-408-9558
  • Fax: 888-393-5922
Mailing address:
  • Phone: 469-408-9558
  • Fax: 888-393-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number30918
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101269105
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberTM2022-0111
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2020-00720
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberS4198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: