Provider Demographics
NPI:1518279553
Name:SHAKYA, UJJWAL (DPT)
Entity Type:Individual
Prefix:
First Name:UJJWAL
Middle Name:
Last Name:SHAKYA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6717 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2717
Mailing Address - Country:US
Mailing Address - Phone:703-490-6726
Mailing Address - Fax:703-494-2171
Practice Address - Street 1:14524 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6803
Practice Address - Country:US
Practice Address - Phone:703-490-6726
Practice Address - Fax:703-494-2171
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305206485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist