Healthcare Provider Details

I. General information

NPI: 1336776236
Provider Name (Legal Business Name): SHIRA KAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N WASHINGTON AVE
BERGENFIELD NJ
07621-1751
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10, SUITE 320
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 201-384-0300
  • Fax: 201-384-9518
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11761900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: