Provider Demographics
NPI:1356500532
Name:SOOD, SHIVANI (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-2655
Mailing Address - Fax:860-887-9003
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2655
Practice Address - Fax:860-887-9003
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT046556207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00687675OtherMEDICARE RAILROAD PTAN
CT010046556CT01OtherANTHEM BLUE CROSS BLUE SHIELD OF CT
CT046556OtherCONNECTICARE, INC
9643135OtherAETNA
P3929070OtherOXFORD
CT010046556CT01OtherANTHEM BLUE CROSS BLUE SHIELD OF CT