Provider Demographics
NPI:1073519658
Name:HUSSAIN, SHAHNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:
Last Name:HUSSAIN
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-667-1244
Mailing Address - Fax:860-666-5153
Practice Address - Street 1:18 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2647
Practice Address - Country:US
Practice Address - Phone:860-667-1244
Practice Address - Fax:860-666-5153
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01373OtherGHMC GRP MEDICARE ID
CTP1252377OtherOXFORD PROV ID
CT010024449CT04OtherBCBS N BCFP PROV ID
CT050040OtherCONNECTICARE PROV ID
CT0V4120OtherHEALTH NET PROV ID
CT1255448155OtherGHMC GRP NPI ID
CT103714OtherWELLCARE MEDICARE
CT581417OtherAETNA REF ID
CT001244490Medicaid
CT004215324Medicaid
CT01024449OtherCIGNA PROV ID
CT110178633OtherRAIL ROAD MEDICARE ID
D02670Medicare UPIN
CT004215324Medicaid