Provider Demographics
NPI:1306015714
Name:BULSARA, MANISHA K (PA-C)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:K
Last Name:BULSARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-317-6874
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:SUITE 175
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1000
Practice Address - Country:US
Practice Address - Phone:347-328-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011671363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical