Provider Demographics
NPI:1609078708
Name:BURKE, SHAYNA BETH (MD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:BETH
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2227
Mailing Address - Country:US
Mailing Address - Phone:860-233-6293
Mailing Address - Fax:860-236-7223
Practice Address - Street 1:928 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2227
Practice Address - Country:US
Practice Address - Phone:860-233-6293
Practice Address - Fax:860-236-7223
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01038208000000X
CT050699207K00000X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology