| Doctor Name: | MITA SHAH BHAGAT |
| NPI Number: | 1063819951 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 13175 Fox Hunt Ln 163 Herndon, VA - 201715389 |
| Business Phone Number: | 9089223743 |
| Business Fax Number: | |
| Mailing Address: | 13175 Fox Hunt Ln, 163 HERNDON |
| State: | VA |
| Postal Code: | 201715389 |
| Phone Number: | 9089223743 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2014 |
| NPI Last Update Date: | 11/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |