Provider Demographics
NPI:1366219453
Name:SHYTAJ, ALESANDRO
Entity type:Individual
Prefix:
First Name:ALESANDRO
Middle Name:
Last Name:SHYTAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2205
Mailing Address - Country:US
Mailing Address - Phone:973-980-1828
Mailing Address - Fax:
Practice Address - Street 1:383 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2205
Practice Address - Country:US
Practice Address - Phone:973-389-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0451008535343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)