Provider Demographics
NPI:1649584525
Name:GAUDANI, SHASHWAT
Entity type:Individual
Prefix:
First Name:SHASHWAT
Middle Name:
Last Name:GAUDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3300
Mailing Address - Country:US
Mailing Address - Phone:609-371-9000
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520-3300
Practice Address - Country:US
Practice Address - Phone:609-371-9000
Practice Address - Fax:609-371-0037
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NJ28RI03285200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy