Provider Demographics
NPI:1215248109
Name:GOYAL, SHAVETA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAVETA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 GALLOWS RD STE D
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3962
Mailing Address - Country:US
Mailing Address - Phone:703-592-4600
Mailing Address - Fax:703-592-4601
Practice Address - Street 1:11211 WAPLES MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7414
Practice Address - Country:US
Practice Address - Phone:703-592-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0081807207Q00000X
VA01012614352083B0002X, 207Q00000X
ND12632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD555690YVZMedicare PIN
MD555740YWV2Medicare PIN
MD555690ZDDBMedicare PIN