Provider Demographics
NPI:1487008033
Name:STETSON, SHIREL AMAR (MD)
Entity Type:Individual
Prefix:
First Name:SHIREL
Middle Name:AMAR
Last Name:STETSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIREL
Other - Middle Name:ELYSSA
Other - Last Name:AMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:198 VAN VORST ST APT 317
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6314
Mailing Address - Country:US
Mailing Address - Phone:609-350-2832
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10568300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics