Provider Demographics
NPI:1255375028
Name:WINDHAM RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:WINDHAM RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST/CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:HADEER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIKHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-423-2323
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0793
Mailing Address - Country:US
Mailing Address - Phone:860-423-2323
Mailing Address - Fax:860-456-8022
Practice Address - Street 1:95 STORRS RD
Practice Address - Street 2:SUITE 13
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-4012
Practice Address - Country:US
Practice Address - Phone:860-423-2323
Practice Address - Fax:860-456-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01519Medicare PIN