Provider Demographics
NPI:1952912917
Name:BHAKTA, SHIV (PA)
Entity type:Individual
Prefix:
First Name:SHIV
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
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Mailing Address - Street 1:1601 W HEBRON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6342
Mailing Address - Country:US
Mailing Address - Phone:972-426-8675
Mailing Address - Fax:972-492-4694
Practice Address - Street 1:1601 W HEBRON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6342
Practice Address - Country:US
Practice Address - Phone:972-426-8675
Practice Address - Fax:972-492-4694
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA16244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant