Provider Demographics
NPI:1720440431
Name:TLANDA, SCOTT JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JEFFREY
Last Name:TLANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 NURSERY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:361-575-0611
Mailing Address - Fax:361-579-6913
Practice Address - Street 1:11016 AMELINA LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-7679
Practice Address - Country:US
Practice Address - Phone:972-310-2106
Practice Address - Fax:972-435-4433
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS19352084P0800X, 2084P0804X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program