Provider Demographics
NPI:1356382105
Name:SHAKED, DANA (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:SHAKED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06881-0306
Mailing Address - Country:US
Mailing Address - Phone:203-434-2232
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2413
Practice Address - Country:US
Practice Address - Phone:202-227-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics