Healthcare Provider Details

I. General information

NPI: 1225612005
Provider Name (Legal Business Name): SHIVALI GOVANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 50TH STREET
BROOKLYN NY
11220
US

IV. Provider business mailing address

31 KATIE CT
EAST HANOVER NJ
07936-3538
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7000
  • Fax:
Mailing address:
  • Phone: 862-579-7673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number111331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: