Provider Demographics
NPI:1790731487
Name:SHETH, MANJU (MD)
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANJU
Other - Middle Name:
Other - Last Name:CHAWLANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4065
Mailing Address - Country:US
Mailing Address - Phone:978-304-8370
Mailing Address - Fax:978-304-8399
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4065
Practice Address - Country:US
Practice Address - Phone:978-304-8370
Practice Address - Fax:978-304-8399
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0160814Medicaid
H01224Medicare UPIN
A33385Medicare ID - Type Unspecified