Healthcare Provider Details

I. General information

NPI: 1043745391
Provider Name (Legal Business Name): MAULI SHAH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W LOMBARD ST STE A
BALTIMORE MD
21223-3134
US

IV. Provider business mailing address

1400 W LOMBARD ST SUITE A, #2129
BALTIMORE MD
21223-3134
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY200001274
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008931
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05918
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number027949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: