Healthcare Provider Details

I. General information

NPI: 1386570844
Provider Name (Legal Business Name): PUNEET DHALIWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BRYN MAWR DR
PROSPER TX
75078-2436
US

IV. Provider business mailing address

2201 BRYN MAWR DR
PROSPER TX
75078-2436
US

V. Phone/Fax

Practice location:
  • Phone: 469-323-1892
  • Fax:
Mailing address:
  • Phone: 469-323-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: