Healthcare Provider Details

I. General information

NPI: 1801403241
Provider Name (Legal Business Name): ROBIN YADAV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W 15TH ST STE 425
PLANO TX
75093-5848
US

IV. Provider business mailing address

5781 STONE GATE HTS APT 5
JAMESVILLE NY
13078-4512
US

V. Phone/Fax

Practice location:
  • Phone: 972-696-0030
  • Fax: 972-696-0037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: