Healthcare Provider Details

I. General information

NPI: 1528358090
Provider Name (Legal Business Name): SHILPA MONGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 N MAIN ST
CHARLTON MA
01507-1315
US

IV. Provider business mailing address

PO BOX 40
SOUTHBRIDGE MA
01550-0040
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-5981
  • Fax: 508-764-4637
Mailing address:
  • Phone: 508-909-7799
  • Fax: 508-764-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number248838
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: