Healthcare Provider Details

I. General information

NPI: 1790075828
Provider Name (Legal Business Name): DHVANI SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 500
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

12510 PROSPERITY DR STE 200
SILVER SPRING MD
20904-1640
US

V. Phone/Fax

Practice location:
  • Phone: 202-296-3449
  • Fax: 202-296-0301
Mailing address:
  • Phone: 240-485-5210
  • Fax: 240-485-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD045061
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: