MEDICARE: MONA DEVEN SHROFF O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA-1946	MD

General Provider Information

NPI Number	:	1912229865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA DEVEN SHROFF O.D.

Provider Business Mailing Address
First Line	:	6445 SWIMMER ROW WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4962
Country	:	US
Telephone Number	:	443-983-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 SWIMMER ROW WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4962
Country	:	US
Telephone Number	:	443-983-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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