Provider Demographics
NPI:1255810396
Name:DODE, SHAZIA
Entity type:Individual
Prefix:MRS
First Name:SHAZIA
Middle Name:
Last Name:DODE
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 1:320 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-3209
Mailing Address - Country:US
Mailing Address - Phone:860-793-0300
Mailing Address - Fax:203-747-0779
Practice Address - Street 1:320 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-3209
Practice Address - Country:US
Practice Address - Phone:860-793-0300
Practice Address - Fax:203-747-0779
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT166442474344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi