Provider Demographics
NPI:1730656943
Name:AHMADI, SHEFALI PATEL (OD)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:PATEL
Last Name:AHMADI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 TUNXIS PATH
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1348
Mailing Address - Country:US
Mailing Address - Phone:860-550-4956
Mailing Address - Fax:
Practice Address - Street 1:553 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3609
Practice Address - Country:US
Practice Address - Phone:203-309-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist