Healthcare Provider Details

I. General information

NPI: 1629398250
Provider Name (Legal Business Name): SHAZIA SHADANI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 FRANKLIN AVE STE 250
FRANKLIN LAKES NJ
07417-1306
US

IV. Provider business mailing address

100 WILLOWBROOK CT
PARAMUS NJ
07652-1833
US

V. Phone/Fax

Practice location:
  • Phone: 844-777-0910
  • Fax:
Mailing address:
  • Phone: 772-971-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MB08671000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: