Provider Demographics
NPI:1881665693
Name:YOUNAN, SHADDY (MD)
Entity Type:Individual
Prefix:
First Name:SHADDY
Middle Name:
Last Name:YOUNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BORDENTOWN AVE
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859
Mailing Address - Country:US
Mailing Address - Phone:732-727-5376
Mailing Address - Fax:732-727-1391
Practice Address - Street 1:1145 BORDENTOWN AVE
Practice Address - Street 2:SUITE # 10
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859
Practice Address - Country:US
Practice Address - Phone:732-727-0400
Practice Address - Fax:732-727-1391
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA72961207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004413Medicaid
NJ0004413Medicaid
H79712Medicare UPIN