Provider Demographics
NPI:1902894256
Name:GREWAL, SHEEBANI BATHIJA (OD)
Entity Type:Individual
Prefix:MRS
First Name:SHEEBANI
Middle Name:BATHIJA
Last Name:GREWAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 MICHAEL FARADAY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5354
Mailing Address - Country:US
Mailing Address - Phone:703-537-8157
Mailing Address - Fax:571-201-8672
Practice Address - Street 1:1800 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5354
Practice Address - Country:US
Practice Address - Phone:703-537-8157
Practice Address - Fax:571-201-8672
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA276728Medicare PIN