Healthcare Provider Details

I. General information

NPI: 1285543009
Provider Name (Legal Business Name): SHULAMIS BLAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ROUTE 37 W
TOMS RIVER NJ
08755-6423
US

IV. Provider business mailing address

24 HOLDEN SQ
LAKEWOOD NJ
08701-5828
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-8000
  • Fax:
Mailing address:
  • Phone: 214-769-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR27368800
License Number StateNJ
# 2
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: