Provider Demographics
NPI:1023454899
Name:AMIN, SHIVANGI
Entity type:Individual
Prefix:DR
First Name:SHIVANGI
Middle Name:
Last Name:AMIN
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 1:188 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4505
Mailing Address - Country:US
Mailing Address - Phone:301-732-4154
Mailing Address - Fax:240-651-1459
Practice Address - Street 1:701 N ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4005
Practice Address - Country:US
Practice Address - Phone:213-908-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080834208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice