Provider Demographics
NPI:1326326968
Name:KOCHUKUNJU RAJU, SHINE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SHINE
Middle Name:
Last Name:KOCHUKUNJU RAJU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 LEAFWOOD LN
Mailing Address - Street 2:APT 220
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6250
Mailing Address - Country:US
Mailing Address - Phone:516-943-2400
Mailing Address - Fax:
Practice Address - Street 1:UCONN HEALTH CTR
Practice Address - Street 2:263 FARMINGTON AVE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:516-943-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program