Provider Demographics
NPI:1922597830
Name:SHELTON PEDIATRICS
Entity Type:Organization
Organization Name:SHELTON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-437-0346
Mailing Address - Street 1:220 FANS ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2017
Mailing Address - Country:US
Mailing Address - Phone:203-813-6175
Mailing Address - Fax:475-655-2990
Practice Address - Street 1:2 TRAP FALLS RD STE 101
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-828-7185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043900208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty