Healthcare Provider Details

I. General information

NPI: 1669368478
Provider Name (Legal Business Name): SHRADHA DAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK ROAD HOLY NAME MEDICAL CENTER
TEANECK NJ
07666
US

IV. Provider business mailing address

718 TEANECK ROAD HOLY NAME MEDICAL CENTER
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-7041
  • Fax:
Mailing address:
  • Phone: 201-833-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: