Provider Demographics
NPI:1083411698
Name:SHAH, HETVI SANJAYKUMAR
Entity type:Individual
Prefix:
First Name:HETVI SANJAYKUMAR
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-352-8370
Mailing Address - Fax:301-352-8372
Practice Address - Street 1:14501 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4901
Practice Address - Country:US
Practice Address - Phone:301-799-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist