Healthcare Provider Details

I. General information

NPI: 1346849700
Provider Name (Legal Business Name): SHIPRA PRASAD DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 10/18/2020
Certification Date: 09/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DELSEA DR N
GLASSBORO NJ
08028-1435
US

IV. Provider business mailing address

68 GRAMERCY DR
PISCATAWAY NJ
08854-5246
US

V. Phone/Fax

Practice location:
  • Phone: 856-863-5720
  • Fax:
Mailing address:
  • Phone: 732-491-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR17357200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: