Provider Demographics
NPI:1780467746
Name:SHEHATA, NARDEEN N (RPH)
Entity type:Individual
Prefix:DR
First Name:NARDEEN
Middle Name:N
Last Name:SHEHATA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MONICA CT
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1515
Mailing Address - Country:US
Mailing Address - Phone:201-932-6783
Mailing Address - Fax:
Practice Address - Street 1:327 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3704
Practice Address - Country:US
Practice Address - Phone:908-469-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04293600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist