Provider Demographics
NPI:1164115218
Name:SHAKHGILDIAN, NATALIIA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIIA
Middle Name:
Last Name:SHAKHGILDIAN
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:UCONN HEALTH GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:263 FARMINGTON AVENUE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1921
Mailing Address - Country:US
Mailing Address - Phone:860-679-2147
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:HARTFORD HOSPITAL-ADULT PRIMARY CARE
Practice Address - Street 2:132 JEFFERSON STREET
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-972-0200
Practice Address - Fax:860-545-3149
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-01-19
Deactivation Date:2024-01-05
Deactivation Code:
Reactivation Date:2024-01-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program