Provider Demographics
NPI:1376006742
Name:SHAH, NEHAL RAJENDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:NEHAL
Middle Name:RAJENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N BEAUREGARD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1716
Mailing Address - Country:US
Mailing Address - Phone:703-212-7546
Mailing Address - Fax:703-212-7282
Practice Address - Street 1:1900 N BEAUREGARD ST STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1716
Practice Address - Country:US
Practice Address - Phone:703-212-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11303400207N00000X
390200000X
VA0102207797207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program