Provider Demographics
NPI:1275196073
Name:AZHAR, NISHA ANNIE (MD)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:ANNIE
Last Name:AZHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 ROLLINGBROOK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4073
Mailing Address - Country:US
Mailing Address - Phone:281-428-7997
Mailing Address - Fax:
Practice Address - Street 1:855 ROLLINGBROOK DR STE 105
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4073
Practice Address - Country:US
Practice Address - Phone:281-428-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU44612084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry