Healthcare Provider Details

I. General information

NPI: 1144156878
Provider Name (Legal Business Name): SHIVANI PANDEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302A N MAIN ST
FORKED RIVER NJ
08731-2743
US

IV. Provider business mailing address

44 KESWICK RD
EAST WINDSOR NJ
08520-2960
US

V. Phone/Fax

Practice location:
  • Phone: 609-549-6925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03155000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: