Provider Demographics
NPI:1013710649
Name:THAKURIA, SUROVI N/A
Entity type:Individual
Prefix:
First Name:SUROVI
Middle Name:N/A
Last Name:THAKURIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 LOXLEY DR
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3170
Mailing Address - Country:US
Mailing Address - Phone:469-468-9010
Mailing Address - Fax:
Practice Address - Street 1:2609 LOXLEY DR
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3170
Practice Address - Country:US
Practice Address - Phone:469-468-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX981844163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health