Healthcare Provider Details

I. General information

NPI: 1265394712
Provider Name (Legal Business Name): NEPHRONLIFE DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PRAIRIE DR BLDG UNIT1201
PROSPER TX
75078-3828
US

IV. Provider business mailing address

3001 S HARDIN BLVD STE 110-202
MCKINNEY TX
75070-7736
US

V. Phone/Fax

Practice location:
  • Phone: 469-797-7711
  • Fax: 215-491-5750
Mailing address:
  • Phone: 469-797-7711
  • Fax: 214-491-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEEPAK CHANDRAMOHAN
Title or Position: COO
Credential: MD
Phone: 469-797-7711