Provider Demographics
NPI:1962274753
Name:MEDISHUTTLE TRANSPORTATION LLC
Entity type:Organization
Organization Name:MEDISHUTTLE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALMIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-933-1700
Mailing Address - Street 1:34 WENDY WAY
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1047
Mailing Address - Country:US
Mailing Address - Phone:609-933-1700
Mailing Address - Fax:
Practice Address - Street 1:34 WENDY WAY
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1047
Practice Address - Country:US
Practice Address - Phone:609-933-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)