Provider Demographics
NPI:1306854997
Name:MIRZA, FARYAL SARDAR (MD)
Entity Type:Individual
Prefix:
First Name:FARYAL
Middle Name:SARDAR
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FARYAL
Other - Middle Name:SARDAR
Other - Last Name:ALI SHEIKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:UCONN MEDICAL GROUP/ENDOCRINOLOGY ASSOCIATES
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-3245
Practice Address - Fax:860-679-1867
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041645207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1416454Medicaid
CTG14823Medicare UPIN
CT460000105Medicare PIN