Healthcare Provider Details

I. General information

NPI: 1003734674
Provider Name (Legal Business Name): DEVANSHI SANJAY MODI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NASSAU BLVD
GARDEN CITY NY
11530-5314
US

IV. Provider business mailing address

20 RIVER CT APT 610
JERSEY CITY NJ
07310-2204
US

V. Phone/Fax

Practice location:
  • Phone: 516-208-2100
  • Fax:
Mailing address:
  • Phone: 951-772-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number051956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: