Provider Demographics
NPI:1093820433
Name:SHASHATY, PAUL ELIAS (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ELIAS
Last Name:SHASHATY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2501
Mailing Address - Country:US
Mailing Address - Phone:203-246-8007
Mailing Address - Fax:
Practice Address - Street 1:24 LEWIS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2501
Practice Address - Country:US
Practice Address - Phone:203-246-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001313111N00000X
NYX-005230-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31732Medicare UPIN
350001369Medicare ID - Type Unspecified