Provider Demographics
NPI:1548761224
Name:ROY, SHUMITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHUMITA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1197
Mailing Address - Country:US
Mailing Address - Phone:203-272-6007
Mailing Address - Fax:203-272-8895
Practice Address - Street 1:18 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1970
Practice Address - Country:US
Practice Address - Phone:203-272-6007
Practice Address - Fax:203-272-8895
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003658103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist