Provider Demographics
NPI:1932571494
Name:SHAJI, SILPA (PA-C)
Entity Type:Individual
Prefix:
First Name:SILPA
Middle Name:
Last Name:SHAJI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BLUE SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1601
Mailing Address - Country:US
Mailing Address - Phone:609-218-7887
Mailing Address - Fax:
Practice Address - Street 1:105 BLUE SPRING RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1601
Practice Address - Country:US
Practice Address - Phone:609-218-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057924363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical