Healthcare Provider Details

I. General information

NPI: 1053044354
Provider Name (Legal Business Name): SHAMIM N SCHROEDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3059
US

IV. Provider business mailing address

699 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3059
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-0034
  • Fax: 860-242-3301
Mailing address:
  • Phone: 860-242-0034
  • Fax: 860-242-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6782
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6782
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPA100967
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: