Provider Demographics
NPI:1619399896
Name:KHAJANCHI, SHUBHAM
Entity type:Individual
Prefix:
First Name:SHUBHAM
Middle Name:
Last Name:KHAJANCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 HUNTINGREEN LN
Mailing Address - Street 2:APT E
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4326
Mailing Address - Country:US
Mailing Address - Phone:336-749-8476
Mailing Address - Fax:866-422-6431
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2859
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist