Provider Demographics
NPI:1417301904
Name:SHAH, VAISHALIBEN RAJNIKANT
Entity Type:Individual
Prefix:
First Name:VAISHALIBEN
Middle Name:RAJNIKANT
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 1:5223 MADISON AVE
Mailing Address - Street 2:APT B2
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1174
Mailing Address - Country:US
Mailing Address - Phone:517-515-9989
Mailing Address - Fax:
Practice Address - Street 1:5223 MADISON AVE
Practice Address - Street 2:APT B2
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1174
Practice Address - Country:US
Practice Address - Phone:517-515-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant