Provider Demographics
NPI:1366946147
Name:VANI, SHIVANI (PA-C)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:VANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:
Other - Last Name:VANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:7 LISZKA LN
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1657
Mailing Address - Country:US
Mailing Address - Phone:732-725-5726
Mailing Address - Fax:
Practice Address - Street 1:1200 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:973-376-6595
Practice Address - Fax:973-564-6092
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00464700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical