Provider Demographics
NPI:1538322748
Name:MENON, VANI SUNDARAM (MD)
Entity type:Individual
Prefix:DR
First Name:VANI
Middle Name:SUNDARAM
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-472-6134
Mailing Address - Fax:512-472-2928
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:STE 302
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-472-6134
Practice Address - Fax:512-472-2928
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2017-01-03
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Provider Licenses
StateLicense IDTaxonomies
TXQ89582088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3592396-02Medicaid
TX3592396-01Medicaid
TX3592396-02Medicaid