Provider Demographics
NPI:1912106501
Name:DAVOUDI, KAVEH SHAHMOHAMMADI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:SHAHMOHAMMADI
Last Name:DAVOUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9401
Mailing Address - Country:US
Mailing Address - Phone:203-982-2218
Mailing Address - Fax:
Practice Address - Street 1:1449 OLD WATERBURY RD
Practice Address - Street 2:UNIT 101
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-210-6333
Practice Address - Fax:203-502-2615
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043700208600000X, 2086S0102X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD40092962Medicare PIN