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General NPI Number Information
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NPI Number | 1386046621
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Entity Type | Individual
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Provider Name | ISHITA DUSHYANT SHAH
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Gender | Female
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 301 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 301-216-4247
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 FIDLER LN APT 1522
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City | SILVER SPRING
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State | MD
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Zip | 20910-3422
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Country | US
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Telephone | 412-801-1480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 07457
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License Number State | MD
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