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General NPI Number Information
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NPI Number | 1497117634
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Entity Type | Individual
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Provider Name | SUNDEEP MANDAVA MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2016
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 920 MEDICAL PLAZA DR STE 120
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City | SHENANDOAH
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State | TX
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Zip | 77380-3275
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Country | US
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Telephone | 281-298-1144
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Fax | 281-298-1133
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Provider Business Mailing Address
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Address Line | 14960 PARK ROW DR
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City | HOUSTON
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State | TX
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Zip | 77084-5165
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Country | US
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Telephone | 281-298-1144
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Fax | 281-298-1133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | T2917
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | T2917
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License Number State | TX
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