Healthcare Provider Details

I. General information

NPI: 1093635930
Provider Name (Legal Business Name): SHIVANI CHATI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 BRAMBLETON AVE
ROANOKE VA
24018-3612
US

IV. Provider business mailing address

1656 N MAIN ST
ROCKY MOUNT VA
24151-2287
US

V. Phone/Fax

Practice location:
  • Phone: 540-989-6600
  • Fax:
Mailing address:
  • Phone: 540-483-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420094
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: