Healthcare Provider Details

I. General information

NPI: 1962359729
Provider Name (Legal Business Name): SHIVANGI SHEKHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WATERTOWN ST
WATERTOWN MA
02472-2699
US

IV. Provider business mailing address

171 WATERTOWN ST
WATERTOWN MA
02472-2699
US

V. Phone/Fax

Practice location:
  • Phone: 617-467-5113
  • Fax:
Mailing address:
  • Phone: 617-467-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: