{
"Npi": {
"NPI": "1467018754",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHAH PATEL",
"FirstName": "ANJALI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHAH",
"OtherFirstName": "ANJALI",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1950 OLD GALLOWS RD STE 520",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIENNA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22182-3970",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-847-8899",
"MailingAddressFaxNumber": "571-223-6780",
"FirstLinePracticeLocationAddress": "13760 OLD SAINT AUGUSTINE RD STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32258-5492",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-379-9068",
"PracticeLocationAddressFaxNumber": "904-503-0683",
"EnumerationDate": "05/13/2019",
"LastUpdateDate": "10/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "5637",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}