Healthcare Provider Details

I. General information

NPI: 1306898259
Provider Name (Legal Business Name): BRIAN D SHAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/20/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE GENERAL SURGERY
FARMINGTON CT
06030-6227
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT OFFICE
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-8080
  • Fax: 860-679-1420
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number049264
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number049264
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: