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NPI Code Detail

MEDICARE: SHINY DEVATHALA

MEDICARE: SHINY DEVATHALA
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
1225100000XPhysical Therapist2305214531VA

General Provider Information

NPI Number : 1912596578
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHINY DEVATHALA
Provider Business Mailing Address
First Line : 8508 LOCH RAVEN BLVD
Second Line :
City : TOWSON
State : MD
Zip : 21286-2354
Country : US
Telephone Number : 443-469-3426
Fax Number : 410-256-0564
Provider Business Practice Location Address
First Line : 8508 LOCH RAVEN BLVD
Second Line :
City : TOWSON
State : MD
Zip : 21286-2354
Country : US
Telephone Number : 929-526-9789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2021
Last Update Date : 08/03/2021

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Directions to “ SHINY DEVATHALA ” Practice Location

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