Provider Demographics
NPI:1457812273
Name:NAIDOO, SHANE DEVANAND (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:DEVANAND
Last Name:NAIDOO
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 1:454 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2628
Mailing Address - Country:US
Mailing Address - Phone:732-762-3072
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF EMERGENCY MEDICINE, BROOKDALE HOSPITAL MED CNTR
Practice Address - Street 2:1 BROOKDALE PLAZA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:722-571-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD26260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine