Provider Demographics
NPI:1740713098
Name:SOVANI, ESHA SHISHIR
Entity type:Individual
Prefix:
First Name:ESHA
Middle Name:SHISHIR
Last Name:SOVANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESHA
Other - Middle Name:MUKUND
Other - Last Name:CHAHWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 TARANASAY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6959
Mailing Address - Country:US
Mailing Address - Phone:317-374-3096
Mailing Address - Fax:
Practice Address - Street 1:969 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3455
Practice Address - Country:US
Practice Address - Phone:704-866-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist