Provider Demographics
NPI:1740221381
Name:SHAH, DARSHANA VIJAY (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:DARSHANA
Middle Name:VIJAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 N PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1440
Mailing Address - Country:US
Mailing Address - Phone:309-693-8315
Mailing Address - Fax:
Practice Address - Street 1:9204 N PINE TREE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1440
Practice Address - Country:US
Practice Address - Phone:309-693-8315
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide