Provider Demographics
NPI:1407302680
Name:SHITANSHUL, UNKNOWN
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:SHITANSHUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FNU
Other - Middle Name:
Other - Last Name:SHITANSHUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:33 JOHN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1798
Mailing Address - Country:US
Mailing Address - Phone:617-600-7124
Mailing Address - Fax:
Practice Address - Street 1:850 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3443
Practice Address - Country:US
Practice Address - Phone:860-610-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist