Healthcare Provider Details

I. General information

NPI: 1457717274
Provider Name (Legal Business Name): SHIVANGI CHANDRASHEKHAR MOGHE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

104 PRETTYMAN DR
ROCKVILLE MD
20850-4718
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3000
  • Fax:
Mailing address:
  • Phone: 410-949-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04722
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: