Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shadane Jackson, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1366383259

Shadane Jackson, MD is a Student in an Organized Health Care Education/Training Program in Newark, New Jersey. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

201 Lyons Ave
Newark, NJ 07112-2027
Phone: (973) 926-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1366383259
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 3, 2026
Last updated in NPPESApril 3, 2026
Certification dateMarch 28, 2026
Mailing address201 Lyons Ave, Newark, NJ 07112-2027

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