Healthcare Provider Details

I. General information

NPI: 1720178999
Provider Name (Legal Business Name): PATRICIA SHADEK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LINDSLEY DR STE 203
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

25 LINDSLEY DR STE 203
MORRISTOWN NJ
07960-4456
US

V. Phone/Fax

Practice location:
  • Phone: 973-998-7900
  • Fax: 973-998-7910
Mailing address:
  • Phone: 973-998-7900
  • Fax: 973-998-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NN05668100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: