Provider Demographics
NPI:1083775480
Name:KAMDAR, SHIVANI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:KAMDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 HUNT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3565
Mailing Address - Country:US
Mailing Address - Phone:202-388-8179
Mailing Address - Fax:202-388-8164
Practice Address - Street 1:4130 HUNT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3565
Practice Address - Country:US
Practice Address - Phone:202-388-8179
Practice Address - Fax:202-388-8164
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034214207Q00000X
IL036-113674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine