Provider Demographics
NPI:1497904346
Name:SHAIKH, RIZWAN A (MD)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:A
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BROADMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6045
Mailing Address - Country:US
Mailing Address - Phone:647-526-4062
Mailing Address - Fax:860-282-2099
Practice Address - Street 1:21 BROADMEADOW RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6045
Practice Address - Country:US
Practice Address - Phone:647-526-4062
Practice Address - Fax:860-282-2099
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046516207R00000X, 207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine