Provider Demographics
NPI:1053623827
Name:SHETH, HEIDI M
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SENTARA THERAPY SOLUTIONS
Mailing Address - Street 2:984B LASKIN RD.
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3905
Mailing Address - Country:US
Mailing Address - Phone:757-395-6900
Mailing Address - Fax:757-425-7180
Practice Address - Street 1:SENTARA THERAPY SOLUTIONS
Practice Address - Street 2:984B LASKIN RD.
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3905
Practice Address - Country:US
Practice Address - Phone:757-395-6900
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979796Medicaid
496633OtherMEDICARE