Healthcare Provider Details

I. General information

NPI: 1124137591
Provider Name (Legal Business Name): ANISHA WAXALI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 SWEETWATER BLVD SUITE 100
SUGAR LAND TX
77479-3162
US

IV. Provider business mailing address

4780 SWEETWATER BLVD SUITE 100
SUGAR LAND TX
77479-3162
US

V. Phone/Fax

Practice location:
  • Phone: 281-491-0094
  • Fax: 281-491-0111
Mailing address:
  • Phone: 281-491-0094
  • Fax: 281-491-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANISHA V WAXALI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 281-491-0094