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NPI Code Detail

MEDICARE: SHATANA SA'SHAE DENT

MEDICARE: SHATANA SA'SHAE DENT
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1407252620
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHATANA SA'SHAE DENT
Provider Business Mailing Address
First Line : 964 MICHAEL AVE
Second Line :
City : VINELAND
State : NJ
Zip : 08360-6214
Country : US
Telephone Number : 856-300-9467
Fax Number :
Provider Business Practice Location Address
First Line : 770 WOODLANE RD
Second Line :
City : WESTAMPTON
State : NJ
Zip : 08060-3804
Country : US
Telephone Number : 609-247-5928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2014
Last Update Date : 11/16/2014

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Directions to “ SHATANA SA'SHAE DENT ” Practice Location

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