Provider Demographics
NPI:1134577984
Name:SHAIN, JOSHUA (MSAOM)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SHAIN
Suffix:
Gender:M
Credentials:MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ASH CIR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5276
Mailing Address - Country:US
Mailing Address - Phone:203-673-9600
Mailing Address - Fax:
Practice Address - Street 1:6515 MAIN ST STE 4A
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6350
Practice Address - Country:US
Practice Address - Phone:203-673-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty