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General NPI Number Information
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NPI Number | 1457773350
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Entity Type | Organization
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Legal Business Name | NIDRAVEDA, P.A.
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 4358 LOCKHILL SELMA RD STE 106
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City | SHAVANO PARK
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State | TX
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Zip | 78249-4167
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Country | US
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Telephone | 210-686-5000
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Fax | 210-239-5060
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Provider Business Mailing Address
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Address Line | 4358 LOCKHILL SELMA RD STE 106
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City | SHAVANO PARK
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State | TX
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Zip | 78249-4167
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Country | US
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Telephone | 210-686-5000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HANUL S BHANDARI
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Credential | M.D.
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Telephone | 210-686-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | P2828
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | P2828
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License Number State | TX
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