Provider Demographics
NPI:1205633997
Name:CANTEENWALLA, USHTAVAITY DAVAR (MS, CGC)
Entity type:Individual
Prefix:
First Name:USHTAVAITY
Middle Name:DAVAR
Last Name:CANTEENWALLA
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1808
Mailing Address - Country:US
Mailing Address - Phone:646-957-5879
Mailing Address - Fax:
Practice Address - Street 1:298 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1808
Practice Address - Country:US
Practice Address - Phone:908-509-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00022300170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS