Provider Demographics
NPI:1578989802
Name:BAXI, DIVYA SHAH (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:DIVYA
Middle Name:SHAH
Last Name:BAXI
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MISS
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:9049 BRONX AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1714
Mailing Address - Country:US
Mailing Address - Phone:408-477-5600
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST STE 1250
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4419
Practice Address - Country:US
Practice Address - Phone:215-351-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246-000176170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS