Healthcare Provider Details

I. General information

NPI: 1972065043
Provider Name (Legal Business Name): AXIVA INFUSION CENTERS - HT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W CHESTER PIKE STE 438
HAVERTOWN PA
19083-2740
US

IV. Provider business mailing address

1120 W TOWNSHIP LINE RD STE 300
HAVERTOWN PA
19083-4929
US

V. Phone/Fax

Practice location:
  • Phone: 844-442-9482
  • Fax: 844-440-0101
Mailing address:
  • Phone: 610-601-0760
  • Fax: 610-756-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN S SHAPIRO
Title or Position: MANAGING MEMBER
Credential:
Phone: 844-442-9482