=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528683141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEENAKSHI MANIVANNAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2020
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2548 LILLIAN MILLER PKWY STE 100
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-7212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-387-7565
-----------------------------------------------------
Fax | 940-566-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1790 N STONEBRIDGE DR
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-7437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-390-9002
-----------------------------------------------------
Fax | 972-984-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | U9026
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------