Provider Demographics
NPI:1912288069
Name:MEHTA, PUJA SAKHRANI (PA-C)
Entity Type:Individual
Prefix:
First Name:PUJA
Middle Name:SAKHRANI
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LIPSCOMB ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3181
Mailing Address - Country:US
Mailing Address - Phone:817-348-8600
Mailing Address - Fax:817-348-8602
Practice Address - Street 1:1000 LIPSCOMB ST STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-348-8600
Practice Address - Fax:817-348-8602
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106124363A00000X
TXPA09570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant