Provider Demographics
NPI:1639334170
Name:MERCHANT, SHITAL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHITAL
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:14 EVERTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4415
Mailing Address - Country:US
Mailing Address - Phone:973-229-6213
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00104100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant