Healthcare Provider Details

I. General information

NPI: 1891576708
Provider Name (Legal Business Name): SHILPA PATNAIKUNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PLAINSBORO RD
PLAINSBORO NJ
08536-3002
US

IV. Provider business mailing address

660 PLAINSBORO RD
PLAINSBORO NJ
08536-3002
US

V. Phone/Fax

Practice location:
  • Phone: 609-275-9688
  • Fax:
Mailing address:
  • Phone: 609-275-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03160200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: