Provider Demographics
NPI:1346592904
Name:SHAMBHAVI, LLC
Entity Type:Organization
Organization Name:SHAMBHAVI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINI
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-648-9228
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303-0406
Mailing Address - Country:US
Mailing Address - Phone:914-648-9228
Mailing Address - Fax:
Practice Address - Street 1:77 HUDSON ST
Practice Address - Street 2:UNIT #3107
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-8517
Practice Address - Country:US
Practice Address - Phone:914-648-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-07
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08864300207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty