Provider Demographics
NPI:1568495604
Name:ALSTON, SHAWNETTE ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWNETTE
Middle Name:ANN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1221
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:95 SCOVILL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1113
Practice Address - Country:US
Practice Address - Phone:203-709-3800
Practice Address - Fax:203-709-3880
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-11-08
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Provider Licenses
StateLicense IDTaxonomies
CT043703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001437038Medicaid
CT001437038Medicaid
CTI00478Medicare UPIN