Provider Demographics
NPI:1992779300
Name:DHILLON, SHAMINA (MD)
Entity type:Individual
Prefix:
First Name:SHAMINA
Middle Name:
Last Name:DHILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 HIGHWAY 35
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755
Mailing Address - Country:US
Mailing Address - Phone:732-517-0060
Mailing Address - Fax:732-548-7408
Practice Address - Street 1:1907 HIGHWAY 35
Practice Address - Street 2:SUITE 1
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-517-0060
Practice Address - Fax:732-548-7408
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44429207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN315890000Medicaid
MN110234176Medicare ID - Type UnspecifiedRAILROAD
MN315890000Medicaid
MN100000558Medicare ID - Type Unspecified