Provider Demographics
NPI:1447273644
Name:VALLABHANENI, VANI SHREE (MD)
Entity type:Individual
Prefix:DR
First Name:VANI
Middle Name:SHREE
Last Name:VALLABHANENI
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 1:10601 PECAN PARK BLVD, SUITE 203
Mailing Address - Street 2:SLEEP 360 SLEEP DIAGNOSTIC CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750
Mailing Address - Country:US
Mailing Address - Phone:512-810-0360
Mailing Address - Fax:512-918-0361
Practice Address - Street 1:10601 PECAN PARK BLVD, SUITE 203
Practice Address - Street 2:SLEEP 360 SLEEP DIAGNOSTIC CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750
Practice Address - Country:US
Practice Address - Phone:512-810-0360
Practice Address - Fax:512-918-0361
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8988207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170908101Medicaid
TX611049Medicare ID - Type Unspecified
TX170908101Medicaid