Healthcare Provider Details

I. General information

NPI: 1659662906
Provider Name (Legal Business Name): ANUPA RANI MANDAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HILLCREST MEDICAL BLVD
WACO TX
76712-8897
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-202-4000
  • Fax:
Mailing address:
  • Phone: 800-994-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberW2750
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: