Provider Demographics
NPI:1548985849
Name:MITHANI, ANUSHA
Entity type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:MITHANI
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 1:1849 STEWART DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6327
Mailing Address - Country:US
Mailing Address - Phone:972-835-6749
Mailing Address - Fax:
Practice Address - Street 1:5236 W UNIVERSITY DR BLDG 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7889
Practice Address - Country:US
Practice Address - Phone:972-562-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty