Provider Demographics
NPI:1639276827
Name:SHAH, ARVIND T (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:T
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 HIGHLAND AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9300
Mailing Address - Fax:203-754-3196
Practice Address - Street 1:417 HIGHLAND AVE
Practice Address - Street 2:STE 1
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9300
Practice Address - Fax:203-754-3196
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0267292084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010026729CTOtherBLUE CROSS BLUE SHIELD
260001751Medicare ID - Type Unspecified
D74031Medicare UPIN