MEDICARE: JAYASHREE SANGHAVI

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	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	DX2783	MD

General Provider Information

NPI Number	:	1740952654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYASHREE SANGHAVI

Provider Business Mailing Address
First Line	:	4404 DONCASTER DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6797
Country	:	US
Telephone Number	:	845-380-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 DONCASTER DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6797
Country	:	US
Telephone Number	:	845-380-4820
Fax Number	:

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

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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Directions to “ JAYASHREE SANGHAVI ” Practice Location

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