Healthcare Provider Details

I. General information

NPI: 1356310767
Provider Name (Legal Business Name): DAIVA SHETTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DAIVA GIRCHENE M.D.

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

14438 LONG CHANNEL CIR
GERMANTOWN MD
20874-5416
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4941
  • Fax:
Mailing address:
  • Phone: 301-916-8370
  • Fax: 301-916-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0055036
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: