Provider Demographics
NPI:1356085971
Name:SHAH, PRUTHABEN HITESHKUMAR (MD)
Entity Type:Individual
Prefix:MS
First Name:PRUTHABEN
Middle Name:HITESHKUMAR
Last Name:SHAH
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 1:2800 MAIN STREET
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:475-210-5425
Mailing Address - Fax:475-210-5022
Practice Address - Street 1:2800 MAIN STREET
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:475-210-5425
Practice Address - Fax:475-210-5022
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2023-05-25
Deactivation Date:2023-01-18
Deactivation Code:
Reactivation Date:2023-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program