Healthcare Provider Details

I. General information

NPI: 1013545714
Provider Name (Legal Business Name): SHIVANI H VAIDYA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VERONICA AVE STE 102
SOMERSET NJ
08873-6804
US

IV. Provider business mailing address

77 VERONICA AVE STE 102
SOMERSET NJ
08873-6804
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1311
  • Fax:
Mailing address:
  • Phone: 336-716-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2024-01522
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MB12770300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2024-01522
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: