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General NPI Number Information
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NPI Number | 1073659272
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Entity Type | Individual
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Provider Name | SHYAMALI V GODBOLE MD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD LEVY 2 WEST
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-6959
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Fax | 215-456-2356
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Provider Business Mailing Address
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Address Line | 101 E OLNEY AVE SUITE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2421
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Country | US
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Telephone | 215-456-7000
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Fax | 215-456-2356
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | MD053000L
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License Number State | PA
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