Healthcare Provider Details

I. General information

NPI: 1003105875
Provider Name (Legal Business Name): SHIVANGI VACHHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIVANGI PANDYA M.D.

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR STE 408A
FAIRFAX VA
22033-1745
US

IV. Provider business mailing address

211 GIBSON ST NW STE 220
LEESBURG VA
20176-2115
US

V. Phone/Fax

Practice location:
  • Phone: 877-511-4625
  • Fax: 703-204-9006
Mailing address:
  • Phone: 877-511-4625
  • Fax: 703-669-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD041888
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101255671
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: