Provider Demographics
NPI:1447848239
Name:SARVAIYA-SHAH, SHWETA
Entity type:Individual
Prefix:MRS
First Name:SHWETA
Middle Name:
Last Name:SARVAIYA-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 1:3714 HARVEY PENICK DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3951
Mailing Address - Country:US
Mailing Address - Phone:213-631-8465
Mailing Address - Fax:
Practice Address - Street 1:3714 HARVEY PENICK DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3951
Practice Address - Country:US
Practice Address - Phone:213-631-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist