Provider Demographics
NPI:1225262504
Name:SHAH, DHARA
Entity type:Individual
Prefix:
First Name:DHARA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TOWNE CENTER WEST BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1195
Mailing Address - Country:US
Mailing Address - Phone:551-689-3221
Mailing Address - Fax:804-495-0755
Practice Address - Street 1:200 TOWNE CENTER WEST BLVD STE 603
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1195
Practice Address - Country:US
Practice Address - Phone:551-689-3221
Practice Address - Fax:804-495-0755
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021758171W00000X
VA2305207245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No171W00000XOther Service ProvidersContractor