MEDICARE: DR. SHIVENDRA PANDEY M.D.

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	207RN0300X	Nephrology Physician	25MA06669100	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	:	1720044308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVENDRA PANDEY M.D.

Provider Business Mailing Address
First Line	:	19 FULLING MILL LN
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1278
Country	:	US
Telephone Number	:	732-840-0880
Fax Number	:	732-840-3499

Provider Business Practice Location Address
First Line	:	204 JACK MARTIN BLVD
Second Line	:	SUITE C3
City	:	BRICK
State	:	NJ
Zip	:	08724-7770
Country	:	US
Telephone Number	:	732-840-0880
Fax Number	:	732-840-3499

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

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	06/29/2016

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