Provider Demographics
NPI:1831928811
Name:THAKKAR, DISHA
Entity type:Individual
Prefix:
First Name:DISHA
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PALM TRACE LANDINGS DR APT 119
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1886
Mailing Address - Country:US
Mailing Address - Phone:954-615-8214
Mailing Address - Fax:
Practice Address - Street 1:3000 PALM TRACE LANDINGS DR APT 119
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1886
Practice Address - Country:US
Practice Address - Phone:954-615-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program