Provider Demographics
NPI:1164458386
Name:POLIZZI, SHAWN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3716
Mailing Address - Country:US
Mailing Address - Phone:203-848-8704
Mailing Address - Fax:
Practice Address - Street 1:1090 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3716
Practice Address - Country:US
Practice Address - Phone:203-848-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002996363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004250065Medicaid
CTQ06264Medicare UPIN
CT004250065Medicaid