Basic Information
| Provider Information | |||||||||
| NPI: | 1275532095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMANDI | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722342987 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 NE LOOP 286 | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754605004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037850031 | ||||||||
| FaxNumber: | 9727846755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | ME87489 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | Q9990 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | P01794670 | 01 | TX | RAILROAD | OTHER | 267645100 | 05 | FL | MEDICAID | 200681210A | 01 | OK | OKLAHOMA MEDICAID | OTHER | 362377901 | 05 | TX | MEDICAID |