Healthcare Provider Details

I. General information

NPI: 1902713647
Provider Name (Legal Business Name): SHOSHANA MAYERFELD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TRENTON ST
JACKSON NJ
08527-1622
US

IV. Provider business mailing address

11 TRENTON ST
JACKSON NJ
08527-1622
US

V. Phone/Fax

Practice location:
  • Phone: 410-458-1448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15573900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: