Provider Demographics
NPI:1053980078
Name:THAKKAR, ANJALI
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 OLD YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-8413
Mailing Address - Country:US
Mailing Address - Phone:224-558-0315
Mailing Address - Fax:
Practice Address - Street 1:56 OLD YELLOW SPRING RD APT 14
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2453
Practice Address - Country:US
Practice Address - Phone:224-558-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider