Provider Demographics
NPI:1811777006
Name:DUFORT, SHENIDER (RN, CNM)
Entity type:Individual
Prefix:
First Name:SHENIDER
Middle Name:
Last Name:DUFORT
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 TRANSIT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-3222
Mailing Address - Country:US
Mailing Address - Phone:860-322-9873
Mailing Address - Fax:
Practice Address - Street 1:1281 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3544
Practice Address - Country:US
Practice Address - Phone:203-658-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife