Provider Demographics
NPI:1740008804
Name:SHAH, SEJAL
Entity type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:SHAH
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 1:38 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1041
Mailing Address - Country:US
Mailing Address - Phone:818-471-3951
Mailing Address - Fax:
Practice Address - Street 1:38 SAGE LN
Practice Address - Street 2:
Practice Address - City:BELL CANYON
Practice Address - State:CA
Practice Address - Zip Code:91307-1041
Practice Address - Country:US
Practice Address - Phone:818-471-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700007488225100000X
CA37876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist