Provider Demographics
NPI:1780161240
Name:SHAH, ANJUMAN JAYESH (MS, RDN)
Entity type:Individual
Prefix:MS
First Name:ANJUMAN
Middle Name:JAYESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 N MAIN ST # 177
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4609
Mailing Address - Country:US
Mailing Address - Phone:925-237-1378
Mailing Address - Fax:
Practice Address - Street 1:1630 N MAIN ST # 177
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4609
Practice Address - Country:US
Practice Address - Phone:925-237-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86073485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered