Provider Demographics
NPI:1760594766
Name:MADDAIAH, SHAILA MADDAIAH (MD)
Entity Type:Individual
Prefix:
First Name:SHAILA
Middle Name:MADDAIAH
Last Name:MADDAIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DORLAND FARM COURT
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558
Mailing Address - Country:US
Mailing Address - Phone:609-924-2098
Mailing Address - Fax:609-924-7826
Practice Address - Street 1:120 JOHN STREET
Practice Address - Street 2:FAMILY & CHILDRENS SERVICES OF CENTRAL NJ
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3132
Practice Address - Country:US
Practice Address - Phone:609-924-2098
Practice Address - Fax:609-924-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050976002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1047302Medicaid
NJ1047302Medicaid
MA518166Medicare ID - Type Unspecified