Provider Demographics
NPI:1639335243
Name:SIDHWANI, NISHA (DO)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:SIDHWANI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26424 STRAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:936-270-5500
Mailing Address - Fax:936-270-5505
Practice Address - Street 1:26424 STRAKE DRIVE
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77389-3000
Practice Address - Country:US
Practice Address - Phone:936-270-5500
Practice Address - Fax:936-270-5505
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215128402Medicaid
TX215128402Medicaid
TX297225YKTUMedicare PIN