Provider Demographics
NPI:1396203717
Name:DAMANIYA, THAKKER HARSH (PA-C)
Entity type:Individual
Prefix:
First Name:THAKKER
Middle Name:HARSH
Last Name:DAMANIYA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:HARSH
Other - Middle Name:
Other - Last Name:THAKKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:655 PROMENADE PARKWAY
Mailing Address - Street 2:APT 4069
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5837
Mailing Address - Country:US
Mailing Address - Phone:469-515-4329
Mailing Address - Fax:
Practice Address - Street 1:5500 FRISCO SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3305
Practice Address - Country:US
Practice Address - Phone:214-618-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant