Provider Demographics
NPI:1942355680
Name:RAGHU, SHALINI NAGARAJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:NAGARAJAN
Last Name:RAGHU
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 1:21 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3630
Mailing Address - Country:US
Mailing Address - Phone:201-823-4141
Mailing Address - Fax:201-823-1141
Practice Address - Street 1:765 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-823-4141
Practice Address - Fax:201-823-1141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08140300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129534Medicaid
NJ193166AJBMedicare PIN