Healthcare Provider Details

I. General information

NPI: 1235203423
Provider Name (Legal Business Name): SANAA SHEHATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861
US

IV. Provider business mailing address

PO BOX 997
OLD BRIDGE NJ
08857
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-3700
  • Fax:
Mailing address:
  • Phone: 732-826-4177
  • Fax: 732-607-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08114900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: