Basic Information
| Provider Information | |||||||||
| NPI: | 1386046621 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHAH | ||||||||
| FirstName: | ISHITA | ||||||||
| MiddleName: | DUSHYANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 FIDLER LN APT 1522 | ||||||||
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| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209103422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128011480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 RUSSELL AVE | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012164247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2014 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 07457 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.