Provider Demographics
NPI:1396068870
Name:VAYANI, RADHIKA (DO)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:VAYANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-1800
Mailing Address - Country:US
Mailing Address - Phone:817-800-9102
Mailing Address - Fax:
Practice Address - Street 1:3800 NORTH TARRANT PARKWAY
Practice Address - Street 2:STE 210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:682-593-6660
Practice Address - Fax:888-289-2380
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
822331839OtherIRS
TX215457708Medicaid
TXP00986730OtherRAILROAD MEDICARE
TX215457704Medicaid
TX215457706Medicaid
TX8CX895OtherBCBS
TX8ER781OtherBCBS
TX8ER781OtherBCBS
TXP00986730OtherRAILROAD MEDICARE