Healthcare Provider Details

I. General information

NPI: 1356786727
Provider Name (Legal Business Name): SHEFALI SUDHIR BALLAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST NEW COLLEGE BUILDING, DEPT OF PATHOLOGY
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

2 SAINT MEENA AVE
MANAHAWKIN NJ
08050-5600
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7991
  • Fax: 215-762-7002
Mailing address:
  • Phone: 718-887-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA09930100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA09930100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: