Provider Demographics
NPI:1811203276
Name:SHISSIAS, SARA SHKALIM (OD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SHKALIM
Last Name:SHISSIAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SHKALIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:204 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-1607
Mailing Address - Country:US
Mailing Address - Phone:856-768-2515
Mailing Address - Fax:856-768-7451
Practice Address - Street 1:204 HADDON AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-1607
Practice Address - Country:US
Practice Address - Phone:856-768-2515
Practice Address - Fax:856-768-7451
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002407152W00000X
NJ27OA00632300152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation