Provider Demographics
NPI:1710202841
Name:SHABAN, ERIC SEDAT (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SEDAT
Last Name:SHABAN
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 1:628 HEBRON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-5007
Mailing Address - Country:US
Mailing Address - Phone:203-592-7781
Mailing Address - Fax:
Practice Address - Street 1:628 HEBRON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-494-4600
Practice Address - Fax:860-494-4650
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09704100207RH0002X
CT49707207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty