Provider Demographics
NPI:1356445415
Name:SHADER, LAUREL B (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:B
Last Name:SHADER
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 1:535 HOWELLTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-799-7961
Mailing Address - Fax:
Practice Address - Street 1:374 GRAND AVE
Practice Address - Street 2:FAIR HAVEN COMMUNITY HEALTH CTR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-777-7411
Practice Address - Fax:203-777-8506
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
004235736OtherCOMMUNITY HEALTH NETWORK
5175619OtherCIGNA
1051526OtherAETNA US HEALTHCARE
0282829734OtherCONNECTICARE
P473785OtherOXFORD
CT004235736Medicaid
010028282CT03OtherANTHEM BCBS
0282829734OtherCONNECTICARE
E27109Medicare ID - Type Unspecified