MEDICARE: JESAL NISHIT SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305213481	VA
2	225100000X	Physical Therapist	27909	MD

General Provider Information

NPI Number	:	1295359891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESAL NISHIT SHAH

Provider Business Mailing Address
First Line	:	PO BOX 419666
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-9666
Country	:	US
Telephone Number	:	410-970-8190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 MERRITT BLVD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-2113
Country	:	US
Telephone Number	:	410-285-0920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2020
Last Update Date	:	11/27/2023

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Directions to “ JESAL NISHIT SHAH ” Practice Location

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