MEDICARE: SHANTI GARDENS LLC

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	372600000X	Adult Companion	294564	PA

General Provider Information

NPI Number	:	1528364023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANTI GARDENS LLC

Provider Business Mailing Address
First Line	:	1425 WOODBOURNE RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19057-1504
Country	:	US
Telephone Number	:	215-949-2273
Fax Number	:	215-949-2279

Provider Business Practice Location Address
First Line	:	1425 WOODBOURNE RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19057-1504
Country	:	US
Telephone Number	:	215-949-2273
Fax Number	:	215-949-2279

Authorized Official
Title or Position	:	MEMBER
Name	:	SEJAL PATEL
Credential	:
Telephone Number	:	917-306-5579

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	01/31/2011

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Directions to “SHANTI GARDENS LLC ” Practice Location

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