Provider Demographics
NPI:1558178939
Name:SHOSHANA, SARA F
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:F
Last Name:SHOSHANA
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 1:1500 TEANECK RD APT 419
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3659
Mailing Address - Country:US
Mailing Address - Phone:973-767-9883
Mailing Address - Fax:
Practice Address - Street 1:1500 TEANECK RD APT 419
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3659
Practice Address - Country:US
Practice Address - Phone:973-767-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF12240306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily