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General NPI Number Information
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NPI Number | 1841465291
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Entity Type | Organization
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Legal Business Name | DULLES FOOT ANKLE INSTITUTE, PLC
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 224A CORNWALL ST NW LOUDOUN COMMUNITY HEALTH CENTER
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City | LEESBURG
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State | VA
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Zip | 20176-2701
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Country | US
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Telephone | 703-443-2120
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Fax | 703-443-2033
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Provider Business Mailing Address
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Address Line | PO BOX 616
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City | ASHBURN
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State | VA
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Zip | 20146-0616
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Country | US
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Telephone | 703-443-2000
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Fax | 703-443-2033
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Authorized Official
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Title or Position | SOLE PROPIERTOR
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Name | DR. MEHUL JITENDRA SHAH
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Credential | DPM
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Telephone | 703-443-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0103300893
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License Number State | VA
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