Shabnam Ravadgar, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401416835 Issued in VA

Practice address

494 Elden St Ste 220
Herndon, VA 20170-4543

Phone

(703) 574-1716

Fax

(703) 662-9904

NPI assigned

May 28, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1295114841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "494 ELDEN ST STE 220",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704543",
            "telephone_number": "703-574-1716",
            "fax_number": "703-662-9904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 ELDEN ST STE 220",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704543",
            "telephone_number": "703-574-1716",
            "fax_number": "703-662-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVADGAR",
        "first_name": "SHABNAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-28",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401416835",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21136",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Lynn Rainer, LPC
• Rithika Rajendran
• Kayla Randall
• Sanjana N Rao Martinello, M.A., BCBA, LBA
• Phillip Ratliff, DPT
• Ravi R Iyer
• Shreeya Reddy Ravi
• Richard Elmer Rawson, PSY.D.
• Refreva LLC
• Rachel Ware Reich, BCABA

• General Practice Dentistry in Herndon, VA
• Providers in Herndon, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.