Provider Demographics
NPI:1689680282
Name:SHILLER, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:SHILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4304
Mailing Address - Country:US
Mailing Address - Phone:203-290-1368
Mailing Address - Fax:888-972-1204
Practice Address - Street 1:103 HOLMES RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4304
Practice Address - Country:US
Practice Address - Phone:203-290-1368
Practice Address - Fax:888-972-1204
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151898208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH51181Medicare UPIN