Provider Demographics
NPI:1841601143
Name:SHAH, KHUSHALI
Entity Type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SAND PIT RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4005
Mailing Address - Country:US
Mailing Address - Phone:203-749-5700
Mailing Address - Fax:203-830-8088
Practice Address - Street 1:79 SAND PIT RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-749-5700
Practice Address - Fax:203-830-8088
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206151207R00000X
CT61300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty