Individual
SHIVA MEHTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
765 NJ-10 #203, #203, RANDOLPH, NJ 07869
(973) 659-9991
Mailing address
63 BEVERLY RD, SPRINGFIELD, NJ 07081-3001
(310) 251-2226
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA09318700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223765275
—
NJ
Enumeration date
10/02/2014
Last updated
12/15/2023
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