Provider Demographics
NPI:1114902301
Name:SHAYEGANI, ARYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARYAN
Middle Name:
Last Name:SHAYEGANI
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 1:40 TEMPLE ST
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2715
Mailing Address - Country:US
Mailing Address - Phone:203-785-2020
Mailing Address - Fax:203-785-6123
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 3-A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-2020
Practice Address - Fax:203-785-6123
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25852Medicare UPIN