| Doctor Name: | DR. SHAN SIVENDRA |
| NPI Number: | 1538154307 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 25MA06930200 |
| Business Practice Address: | 94 Old Short Hills Rd Livingston, NJ - 070395672 |
| Business Phone Number: | 2013225000 |
| Business Fax Number: | |
| Mailing Address: | 66 W Gilbert St, TINTON FALLS |
| State: | NJ |
| Postal Code: | 077014918 |
| Phone Number: | 7322120060 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2005 |
| NPI Last Update Date: | 02/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MA06930200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |