Individual
SHRUTI BALWALLI-UDYAWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
149 MAIN ST, SOUTH RIVER, NJ 08882-1232
(732) 238-6440
(732) 651-1232
Mailing address
111 JAMES ST, EDISON, NJ 08820-3967
(732) 452-9700
(732) 452-9720
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ00769400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ00769400
LICENSE
NJ
Enumeration date
01/22/2018
Last updated
02/24/2020
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