Active NPI
Phyllis Shetty, M.D.
- Anesthesiology Physician
- Mount Laurel, NJ
National Provider Identifier
1730245333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 25MA03821300
- Practice address
- 130 Gaither Dr
Mount Laurel, NJ 08054-1715 - Phone
- (856) 722-7000
- Fax
- (856) 829-0580
- NPI assigned
- Dec 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 25MA03821300 | NJ | Primary |
Addresses
Primary practice location
130 Gaither Dr
Mount Laurel, NJ 08054-1715
Mailing address
700 US RT 130 N
Suite 203
Cinnaminson, NJ 08077
Phone (856) 829-9345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA03821300 | NJ | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730245333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 US RT 130 N",
"address_2": "SUITE 203",
"city": "CINNAMINSON",
"state": "NJ",
"postal_code": "08077",
"telephone_number": "856-829-9345",
"fax_number": "856-829-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 GAITHER DR",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080541715",
"telephone_number": "856-722-7000",
"fax_number": "856-829-0580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHETTY",
"first_name": "PHYLLIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NJ",
"license": "25MA03821300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Laurel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.