Provider Demographics
NPI:1841229622
Name:ZAX, SHOSHANA (RN)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:ZAX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:ZAX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LNM
Mailing Address - Street 1:60 WASHINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3271
Mailing Address - Country:US
Mailing Address - Phone:203-230-2939
Mailing Address - Fax:203-287-1845
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-230-2939
Practice Address - Fax:203-287-1845
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE47317174400000X
CT000016367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004183406Medicaid