Provider Demographics
NPI:1508312893
Name:SHAIKH, TEJAL KOTHARI (DO)
Entity Type:Individual
Prefix:
First Name:TEJAL
Middle Name:KOTHARI
Last Name:SHAIKH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-0518
Mailing Address - Country:US
Mailing Address - Phone:860-653-4526
Mailing Address - Fax:
Practice Address - Street 1:13 CHURCH RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9406
Practice Address - Country:US
Practice Address - Phone:860-653-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty