Provider Demographics
NPI:1497474233
Name:SHAH, JAYATI ANAND
Entity Type:Individual
Prefix:DR
First Name:JAYATI
Middle Name:ANAND
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 1:481 NORTHLAKE DR APT 109
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1319
Mailing Address - Country:US
Mailing Address - Phone:408-429-0794
Mailing Address - Fax:
Practice Address - Street 1:481 NORTHLAKE DR APT 109
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1319
Practice Address - Country:US
Practice Address - Phone:408-429-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist