Provider Demographics
NPI:1902883788
Name:MANSURIA, SHETAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHETAL
Middle Name:M
Last Name:MANSURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2107
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-7707
Mailing Address - Country:US
Mailing Address - Phone:973-535-3800
Mailing Address - Fax:973-535-3808
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 213
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-3800
Practice Address - Fax:973-535-3808
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064937Medicare ID - Type Unspecified
NJH76146Medicare UPIN