Individual
MITA D SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
10875 MAIN ST STE 105, FAIRFAX, VA 22030-4732
(703) 352-4121
(703) 352-4122
Mailing address
12932 CEDAR GLEN LN, HERNDON, VA 20171-2951
(703) 689-4933
(703) 689-3849
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101232722
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010253985
—
VA
Enumeration date
09/03/2006
Last updated
02/16/2026
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