Provider Demographics
NPI:1598005530
Name:MAKANJI, DISHA (PA)
Entity Type:Individual
Prefix:MRS
First Name:DISHA
Middle Name:
Last Name:MAKANJI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DISHA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 ROCHE BROS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:781-344-3535
Mailing Address - Fax:866-388-2185
Practice Address - Street 1:15 ROCHE BROS WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:781-344-3535
Practice Address - Fax:866-388-2185
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical