Provider Demographics
NPI:1275394579
Name:SHAH, ADITI SARAN (AMFT)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:SARAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVER OAKS PKWY UNIT 1372
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3614
Mailing Address - Country:US
Mailing Address - Phone:214-228-3315
Mailing Address - Fax:
Practice Address - Street 1:1760 THE ALAMEDA STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1728
Practice Address - Country:US
Practice Address - Phone:408-963-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist