Healthcare Provider Details

I. General information

NPI: 1346156916
Provider Name (Legal Business Name): JASMIN SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14635 BALTIMORE AVE UNIT B
LAUREL MD
20707-4902
US

IV. Provider business mailing address

14635 BALTIMORE AVE UNIT B
LAUREL MD
20707-4902
US

V. Phone/Fax

Practice location:
  • Phone: 240-581-5740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3172
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: