Basic Information
| Provider Information | |||||||||
| NPI: | 1780908608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHETH | ||||||||
| FirstName: | ANJALI | ||||||||
| MiddleName: | BIPIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805036499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037723300 | ||||||||
| FaxNumber: | 3036823380 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805036499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037723300 | ||||||||
| FaxNumber: | 3036823380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2010 | ||||||||
| LastUpdateDate: | 05/10/2018 | ||||||||
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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 | 207W00000X | P9730 | TX | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207WX0009X | DR.0054968 | CO | Y |
ID Information
| ID | Type | State | Issuer | Description | 34037217 | 05 | CO | MEDICAID |