Provider Demographics
NPI:1316372824
Name:BHAKTA, CHANDNI SHAILESH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHANDNI
Middle Name:SHAILESH
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2950 CULLEN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3922
Mailing Address - Country:US
Mailing Address - Phone:281-412-6262
Mailing Address - Fax:281-412-6740
Practice Address - Street 1:2950 CULLEN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3922
Practice Address - Country:US
Practice Address - Phone:281-412-6262
Practice Address - Fax:281-412-6740
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA08732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant