Provider Demographics
NPI:1336703586
Name:JOSEPH, SHAZIA JOSEPHINE (APRN)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:JOSEPHINE
Last Name:JOSEPH
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 1:12 VILLAGE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3828
Mailing Address - Country:US
Mailing Address - Phone:203-843-4629
Mailing Address - Fax:
Practice Address - Street 1:12 VILLAGE ST STE 5
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3828
Practice Address - Country:US
Practice Address - Phone:203-843-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.008172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine