Provider Demographics
NPI:1992807945
Name:SHOULSON, SHANA S (MD)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:S
Last Name:SHOULSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:KAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:436 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2146
Mailing Address - Country:US
Mailing Address - Phone:732-745-5992
Mailing Address - Fax:732-673-0384
Practice Address - Street 1:24 STELTON RD STE A
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2639
Practice Address - Country:US
Practice Address - Phone:732-424-0440
Practice Address - Fax:732-424-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06419500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072761Medicaid
NJ0072761Medicaid
NJ025962Medicare PIN