Healthcare Provider Details

I. General information

NPI: 1184737751
Provider Name (Legal Business Name): SHOREVIEW MEDICAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28312 LEWES-GEORGETOWN HIGHWAY COOL SPRING OFFICE PARK
MILTON DE
19968
US

IV. Provider business mailing address

28312 LEWES-GEORGETOWN HIGHWAY COOL SPRING OFFICE PARK
MILTON DE
19968
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-0990
  • Fax: 302-684-0991
Mailing address:
  • Phone: 302-684-0990
  • Fax: 302-684-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002106107
License Number StateDE

VIII. Authorized Official

Name: UDAY JANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-684-0990