Provider Demographics
NPI:1417571274
Name:SHAH, ANJLI AJIT
Entity Type:Individual
Prefix:
First Name:ANJLI
Middle Name:AJIT
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 1:620 SE OAK STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-747-3096
Mailing Address - Fax:503-747-3735
Practice Address - Street 1:620 SE OAK STREET
Practice Address - Street 2:SUITE E
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-747-3096
Practice Address - Fax:503-747-3735
Is Sole Proprietor?:No
Enumeration Date:2020-06-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
OR4451175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath