Provider Demographics
NPI:1083635940
Name:CLOTT, SHILPA MAHENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:MAHENDRA
Last Name:CLOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHILPA
Other - Middle Name:MAHENDRA
Other - Last Name:RADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 MOUNTAIN BLVD BLDG T
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5648
Mailing Address - Country:US
Mailing Address - Phone:908-222-0070
Mailing Address - Fax:908-374-6152
Practice Address - Street 1:31 MOUNTAIN BLVD BLDG T
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5648
Practice Address - Country:US
Practice Address - Phone:908-222-0070
Practice Address - Fax:908-374-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07063500207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH50808Medicare UPIN
NJSC052291Medicare ID - Type Unspecified