Provider Demographics
NPI:1457553513
Name:SHAH, HANSA H (MD)
Entity Type:Individual
Prefix:DR
First Name:HANSA
Middle Name:H
Last Name:SHAH
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 1:399 MILL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2865
Mailing Address - Country:US
Mailing Address - Phone:888-822-2270
Mailing Address - Fax:203-336-4395
Practice Address - Street 1:399 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2865
Practice Address - Country:US
Practice Address - Phone:888-822-2270
Practice Address - Fax:203-336-4395
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TA0400X, 103TC2200X, 103TF0000X
CT019875103TC0700X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004238764Medicaid
CT004052023Medicaid
CT004258366Medicaid
CT004258374Medicaid
CT004191962Medicaid
CT004259025Medicaid
CT004188282Medicaid