Provider Demographics
NPI:1144488321
Name:DWIVEDI, SHAUNAK A (DO)
Entity type:Individual
Prefix:DR
First Name:SHAUNAK
Middle Name:A
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 GOODWIN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4268
Mailing Address - Country:US
Mailing Address - Phone:516-314-1485
Mailing Address - Fax:
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-521-0800
Practice Address - Fax:732-521-0833
Is Sole Proprietor?:No
Enumeration Date:2008-05-24
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08928100207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology