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General NPI Number Information
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NPI Number | 1518279553
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Entity Type | Individual
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Provider Name | UJJWAL SHAKYA D.P.T
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Gender | Male
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 14524 POTOMAC MILLS RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6803
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Country | US
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Telephone | 703-490-6726
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Fax | 703-494-2171
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Provider Business Mailing Address
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Address Line | 6717 WESTCOTT RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-2717
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Country | US
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Telephone | 703-490-6726
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Fax | 703-494-2171
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206485
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License Number State | VA
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