Provider Demographics
NPI:1558773531
Name:KUMAR, SHRUTI
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:KUMAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2142
Mailing Address - Country:US
Mailing Address - Phone:203-843-9010
Mailing Address - Fax:860-295-9734
Practice Address - Street 1:4A DEVINE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2142
Practice Address - Country:US
Practice Address - Phone:202-843-9010
Practice Address - Fax:860-295-9734
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61574207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine