Provider Demographics
NPI:1750991006
Name:DHUDASIA, SHEETAL
Entity type:Individual
Prefix:
First Name:SHEETAL
Middle Name:
Last Name:DHUDASIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEETAL
Other - Middle Name:
Other - Last Name:MARVANIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19350 WINMEADE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6506
Mailing Address - Country:US
Mailing Address - Phone:571-333-7244
Mailing Address - Fax:571-333-0720
Practice Address - Street 1:19350 WINMEADE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6506
Practice Address - Country:US
Practice Address - Phone:571-333-7244
Practice Address - Fax:571-333-0720
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17215183500000X
VA0202206798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist