Individual provider Active NPI

Shivani Patel

  • Nurse Practitioner
  • Delran, NJ
National Provider Identifier
1396339990
Registry record updated Feb 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ01115000 Issued in NJ
Practice address
8008 Route 130 Ste 120
Delran, NJ 08075-1869
Phone
(844) 542-2273
NPI assigned
Feb 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP023181 PA
Nurse Practitioner 363L00000X 26NJ01115000 NJ Primary

Addresses

Primary practice location

8008 Route 130 Ste 120
Delran, NJ 08075-1869

Mailing address

400 Laurel Oak Rd Ste 105
Voorhees, NJ 08043-4455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210504003094 NJ Practitioner - Nurse Practitioner 5395154355 Reassigns benefits to 2 organizations
I20240617003958 PA Practitioner - Nurse Practitioner 5395154355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

73 N Maple Ave B
Kennedy Health Alliance
Marlton, NJ 08053-1782
Phone (844) 542-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ01115000NJMDNurse Practitioner
SP023181PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice, P.C. CurrentSince Jun 1, 2021 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Jun 15, 2021 Accepting new patients
Visavis Health Care Medical Group of NJ LLC CurrentSince Apr 1, 2024 Accepting new patients
Visavis Health Care Medical Group of Pennsylvania PLLC CurrentSince May 1, 2024 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Jun 1, 2021 Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

8008 Route 130
Ste 120
Delran, NJ 08075
Phone (856) 764-7997

73 N Maple Ave
Ste B
Marlton, NJ 08053
Phone (856) 596-0558

73 N Maple Ave
Marlton, NJ 08053
Phone (856) 352-6660

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

400 Laurel Oak Rd
Ste 105
Voorhees, NJ 08043
Phone (609) 304-0991

250 Skillman St
Ste 204
Brooklyn, NY 11205
Phone (513) 341-7173

831 Bedford Ave
Brooklyn, NY 11205

30 West Ave
Wayne, PA 19087
Phone (610) 688-3235

7300 State Highway 121
Ste 300374
McKinney, TX 75070

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644019200000",
    "number": "1396339990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LAUREL OAK RD STE 105",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 ROUTE 130 STE 120",
            "city": "DELRAN",
            "state": "NJ",
            "postal_code": "080751869",
            "telephone_number": "844-542-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHIVANI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-24",
        "last_updated": "2022-02-05",
        "certification_date": "2022-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP023181",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ01115000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delran, NJ

Sources for this page

Verify at the official NPI Registry.