Provider Demographics
NPI:1609211499
Name:SHAHINIAN, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHAHINIAN
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 1:32 DITTMAR RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2648
Mailing Address - Country:US
Mailing Address - Phone:203-470-7072
Mailing Address - Fax:
Practice Address - Street 1:268 GREENWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2436
Practice Address - Country:US
Practice Address - Phone:203-470-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist