Provider Demographics
NPI:1093082414
Name:SHIROMANI, ANJELICA (DPT)
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:
Last Name:SHIROMANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PRINCE ST STE 402B
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1600
Mailing Address - Country:US
Mailing Address - Phone:203-752-7878
Mailing Address - Fax:203-776-4989
Practice Address - Street 1:46 PRINCE ST STE 402B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-752-7878
Practice Address - Fax:203-776-4989
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist