Healthcare Provider Details

I. General information

NPI: 1427021351
Provider Name (Legal Business Name): SHAILEN JALALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E TOWNSHIP LINE RD FIRST FLOOR
HAVERTOWN PA
19083-5733
US

IV. Provider business mailing address

PO BOX 33465
BELFAST ME
04915-0612
US

V. Phone/Fax

Practice location:
  • Phone: 484-458-1000
  • Fax: 484-458-1001
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA07859500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD036877E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: