Healthcare Provider Details

I. General information

NPI: 1164865085
Provider Name (Legal Business Name): SHUCHI S JANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST DEPT OF PEDIATRICS
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5260
  • Fax: 718-780-3266
Mailing address:
  • Phone: 718-780-5260
  • Fax: 718-780-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number300620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: