Healthcare Provider Details

I. General information

NPI: 1083775480
Provider Name (Legal Business Name): SHIVANI KAMDAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8179
  • Fax: 202-388-8164
Mailing address:
  • Phone: 202-388-8179
  • Fax: 202-388-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034214
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-113674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: