Provider Demographics
NPI:1336140029
Name:CORBETT, SHONDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHONDA
Middle Name:M
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHONDA
Other - Middle Name:
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 UNIVERSITY PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6208
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:
Practice Address - Street 1:718 TEANECK RD STE 301
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:551-288-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228897207V00000X
NJ25MA09967200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461585Medicaid
BC8354223OtherDEA
NY228897-1OtherNYS MEDICAL LICENSE
NYI02241Medicare UPIN
NY02461585Medicaid