Healthcare Provider Details

I. General information

NPI: 1972399905
Provider Name (Legal Business Name): SHIVANI RAJESH MAHAJAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PLACE TOWER 1 11TH FLOOR
BRONX NY
10461
US

IV. Provider business mailing address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4461
  • Fax: 347-577-4596
Mailing address:
  • Phone: 404-501-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: