Provider Demographics
NPI:1700400298
Name:JOSEPH, SHALU MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALU
Middle Name:MARIA
Last Name:JOSEPH
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 1:645 PENN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3527
Mailing Address - Country:US
Mailing Address - Phone:610-988-4838
Mailing Address - Fax:
Practice Address - Street 1:838 PENN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1108
Practice Address - Country:US
Practice Address - Phone:610-988-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-11-16
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-14
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD479484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1042323830001Medicaid