Provider Demographics
NPI:1215248109
Name:GOYAL, SHAVETA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAVETA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SUMMIT MANOR CT APT 106
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5744
Mailing Address - Country:US
Mailing Address - Phone:701-200-9458
Mailing Address - Fax:
Practice Address - Street 1:6201 CENTREVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2626
Practice Address - Country:US
Practice Address - Phone:703-830-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0081807207Q00000X, 207Q00000X
VA0101261435207Q00000X
ND12632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD555690YVZMedicare PIN
MD555740YWV2Medicare PIN
MD555690ZDDBMedicare PIN