Provider Demographics
NPI:1376430819
Name:SHAWALY, SUZAN
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:SHAWALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 BROWERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2663
Mailing Address - Country:US
Mailing Address - Phone:973-837-8830
Mailing Address - Fax:973-837-8831
Practice Address - Street 1:279 BROWERTOWN RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2663
Practice Address - Country:US
Practice Address - Phone:973-837-8830
Practice Address - Fax:973-837-8831
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04362500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist