1629287511 NPI number — MRS. JODY SHAPIRO GANDY PT, PHD

Table of content: MRS. JODY SHAPIRO GANDY PT, PHD (NPI 1629287511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629287511 NPI number — MRS. JODY SHAPIRO GANDY PT, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDY
Provider First Name:
JODY
Provider Middle Name:
SHAPIRO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAPIRO
Provider Other First Name:
JODY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629287511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2409 ALTENBURG CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20603-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-374-6985
Provider Business Mailing Address Fax Number:
301-374-6985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 NORTH FAIRFAX STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-1488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-706-3201
Provider Business Practice Location Address Fax Number:
703-706-3387
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 000982-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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