Provider Demographics
NPI:1467087783
Name:PANWAR, SHANKAR
Entity Type:Individual
Prefix:
First Name:SHANKAR
Middle Name:
Last Name:PANWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2626
Mailing Address - Country:US
Mailing Address - Phone:203-668-3554
Mailing Address - Fax:860-426-2898
Practice Address - Street 1:K 11, 1783 MERIDEN WATERBURY TPKE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:203-404-1010
Practice Address - Fax:860-426-2898
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical