Healthcare Provider Details

I. General information

NPI: 1689268922
Provider Name (Legal Business Name): NANCY SHORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HAMBURG TPKE
WAYNE NJ
07470-6226
US

IV. Provider business mailing address

2440 HAMBURG TPKE
WAYNE NJ
07470-6226
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3400
  • Fax:
Mailing address:
  • Phone: 973-839-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01120600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: