Healthcare Provider Details

I. General information

NPI: 1043956188
Provider Name (Legal Business Name): HIMA SHETH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 AGEE TER
MIDLOTHIAN VA
23114-4664
US

IV. Provider business mailing address

1106 AGEE TER
MIDLOTHIAN VA
23114-4664
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-6295
  • Fax:
Mailing address:
  • Phone: 720-401-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024184295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: