MEDICARE: SHAILENDER KARRY MOHANRAO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA08279900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093745077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILENDER KARRY MOHANRAO MD

Provider Business Mailing Address
First Line	:	2115 MILLBURN AVE
Second Line	:	STE L2
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3714
Country	:	US
Telephone Number	:	973-275-1322
Fax Number	:	973-900-8453

Provider Business Practice Location Address
First Line	:	2115 MILLBURN AVE
Second Line	:	SUITE L2
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3724
Country	:	US
Telephone Number	:	973-275-1322
Fax Number	:	973-900-8917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/25/2019

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