Provider Demographics
NPI:1720723109
Name:SHAH, REENA KUNVARJI (PA)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:KUNVARJI
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD STE 602
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4235
Mailing Address - Country:US
Mailing Address - Phone:301-868-9414
Mailing Address - Fax:301-868-6055
Practice Address - Street 1:8926 WOODYARD RD STE 602
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4235
Practice Address - Country:US
Practice Address - Phone:301-868-9414
Practice Address - Fax:301-868-6055
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110008771363A00000X
363A00000X
MDC0008727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant