Provider Demographics
NPI:1043752439
Name:SANGHAVI, RAJAVI
Entity Type:Individual
Prefix:
First Name:RAJAVI
Middle Name:
Last Name:SANGHAVI
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 1:4922 LASALLE RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3302
Mailing Address - Country:US
Mailing Address - Phone:301-864-2333
Mailing Address - Fax:877-828-2060
Practice Address - Street 1:900 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2124
Practice Address - Country:US
Practice Address - Phone:410-267-8653
Practice Address - Fax:877-828-2060
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01308L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4374045-00Medicaid
MD1447657507OtherNPI TYPE 2/ ORGANIZATION NPI
MD337361,337362Medicare PIN
MD4374045-00Medicaid