Healthcare Provider Details

I. General information

NPI: 1700521119
Provider Name (Legal Business Name): SHIVANI SINHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 JOLLEY DR
BLOOMFIELD CT
06002-3092
US

IV. Provider business mailing address

47 JOLLEY DR
BLOOMFIELD CT
06002-3092
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-3020
  • Fax: 860-243-3002
Mailing address:
  • Phone: 860-243-3020
  • Fax: 860-243-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number83901
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: