Healthcare Provider Details

I. General information

NPI: 1003725680
Provider Name (Legal Business Name): SHANI F SPENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 EAGLE ROCK AVE STE 3
WEST ORANGE NJ
07052-2948
US

IV. Provider business mailing address

623 EAGLE ROCK AVE STE 3
WEST ORANGE NJ
07052-2948
US

V. Phone/Fax

Practice location:
  • Phone: 973-255-1150
  • Fax:
Mailing address:
  • Phone: 973-255-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00133400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: