Healthcare Provider Details

I. General information

NPI: 1790722163
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF CAPE MAY COUNTY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S SHORE RD MARMORA MEDICAL COMMONS, SUITE 100
MARMORA NJ
08223-1200
US

IV. Provider business mailing address

210 S SHORE RD MARMORA MEDICAL COMMONS, SUITE 100
MARMORA NJ
08223-1200
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-0882
  • Fax:
Mailing address:
  • Phone: 609-390-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05175600
License Number StateNJ

VIII. Authorized Official

Name: DR. SANDEE K SHALLER
Title or Position: PARTNER
Credential: DO
Phone: 609-390-0882