Basic Information
| Provider Information | |||||||||
| NPI: | 1144602921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERFET | ||||||||
| FirstName: | SHONTELLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 MEADOWLANDS PKWY | ||||||||
| Address2: | |||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070942925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5512577038 | ||||||||
| FaxNumber: | 2015522358 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 10TH ST | ||||||||
| Address2: | |||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070942921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5512577038 | ||||||||
| FaxNumber: | 2015522358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00369100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.