Healthcare Provider Details

I. General information

NPI: 1093157513
Provider Name (Legal Business Name): VIJAYASHREE SHRINIVAS MOKASHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD STE 205
ALLENTOWN PA
18103-6271
US

IV. Provider business mailing address

LEHIGH VALLEY HEALTH NETWORK, PO BOX 689
ALLENTOWN PA
18105
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-0100
  • Fax:
Mailing address:
  • Phone: 610-402-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD484055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: