Individual
DR. SHANNON MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 BERGEN ST, NEWARK, NJ 07103-2496
(973) 972-5128
(973) 972-6646
Mailing address
150 BERGEN ST, NEWARK, NJ 07103-2496
(973) 972-5128
(973) 972-6646
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA09979800
NJ
207P00000X
Emergency Medicine Physician
A104212
CA
Other
Enumeration date
02/12/2009
Last updated
04/19/2022
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