Provider Demographics
NPI:1720469810
Name:PAMNANI, SHAILEJA
Entity Type:Individual
Prefix:
First Name:SHAILEJA
Middle Name:
Last Name:PAMNANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 DONAMY GLN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2402
Mailing Address - Country:US
Mailing Address - Phone:203-732-7327
Mailing Address - Fax:
Practice Address - Street 1:1111 DONAMY GLN
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2402
Practice Address - Country:US
Practice Address - Phone:203-732-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10572600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty