Provider Demographics
NPI:1326014341
Name:THAKUR, SHILPA (MD)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:THAKUR
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 1:33 LUCY WAY
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2534
Mailing Address - Country:US
Mailing Address - Phone:617-953-2737
Mailing Address - Fax:
Practice Address - Street 1:WELLNESS WORKS CTR
Practice Address - Street 2:151 FARMINGTON AVE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06156-0001
Practice Address - Country:US
Practice Address - Phone:860-273-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA37240Medicare UPIN
MA7607591OtherUS HEALTHCARE PPO
MAAA15573OtherHARVARD PILGRIM
MAJ27820OtherBLUE CROSS
MA3677232OtherUS HEALTHCARE HMO
MA4693215OtherTUFTS
MA2075270Medicaid
MA110892Medicare UPIN
MD5793895OtherCIGNA