Provider Demographics
NPI:1922667146
Name:THAKER, SHIVANI D (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:D
Last Name:THAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3302
Mailing Address - Country:US
Mailing Address - Phone:732-952-3627
Mailing Address - Fax:
Practice Address - Street 1:963 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3302
Practice Address - Country:US
Practice Address - Phone:732-952-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant