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General NPI Number Information
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NPI Number | 1649798455
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Entity Type | Individual
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Provider Name | SHANDEL DOUGLAS APN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 310 CENTRAL AVENUE SUITE 102
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City | EAST ORANGE
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State | NJ
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Zip | 07018
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Country | US
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Telephone | 973-395-1550
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Fax | 973-395-1556
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Provider Business Mailing Address
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Address Line | 21 EDGEWOOD ROAD
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City | SUMMIT
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State | NJ
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Zip | 07901
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Country | US
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Telephone | 973-395-1550
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Fax | 973-395-1556
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00747600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ00747600
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License Number State | NJ
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