Provider Demographics
NPI:1376726422
Name:SHOTASHVILI, NATALLIA (MD)
Entity type:Individual
Prefix:DR
First Name:NATALLIA
Middle Name:
Last Name:SHOTASHVILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15825 SHADY GROVE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4008
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:301-216-2592
Practice Address - Street 1:8455 COLESVILLE RD STE 1125
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6397
Practice Address - Country:US
Practice Address - Phone:301-615-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine