Provider Demographics
NPI:1003951583
Name:PHANSALKAR, SHUBHA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBHA
Middle Name:M
Last Name:PHANSALKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2610
Mailing Address - Country:US
Mailing Address - Phone:203-629-8819
Mailing Address - Fax:
Practice Address - Street 1:54 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2610
Practice Address - Country:US
Practice Address - Phone:203-629-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT238682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41667Medicare UPIN