Healthcare Provider Details

I. General information

NPI: 1528272432
Provider Name (Legal Business Name): SHASHANK S SHETH M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE D285
VOORHEES NJ
08043-9626
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5187
US

V. Phone/Fax

Practice location:
  • Phone: 856-576-5746
  • Fax: 856-519-5295
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number25MA07836900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD436687
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: