Provider Demographics
NPI:1134583479
Name:MAITRA, SHALINI (MD)
Entity type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:
Last Name:MAITRA
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 1:1003 CHRISTIAN ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3707
Mailing Address - Country:US
Mailing Address - Phone:610-905-6254
Mailing Address - Fax:
Practice Address - Street 1:1600 ROCKLAND RD STE 2B80
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-5874
Practice Address - Fax:302-651-5954
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0006185208000000X
PAMT211318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics