Provider Demographics
NPI:1598050874
Name:SHAHZAD, AYESHA
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:SHAHZAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE RIDGE WAY
Mailing Address - Street 2:#2E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5386
Mailing Address - Country:US
Mailing Address - Phone:203-345-1192
Mailing Address - Fax:
Practice Address - Street 1:315 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3715
Practice Address - Country:US
Practice Address - Phone:203-776-8556
Practice Address - Fax:203-776-1475
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice