Provider Demographics
NPI:1619622560
Name:SHALTOUT, SHARI P
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:P
Last Name:SHALTOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2122
Mailing Address - Country:US
Mailing Address - Phone:609-412-9094
Mailing Address - Fax:
Practice Address - Street 1:6725 VENTNOR AVE STE C
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2166
Practice Address - Country:US
Practice Address - Phone:609-350-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01273800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner