Healthcare Provider Details

I. General information

NPI: 1134224728
Provider Name (Legal Business Name): ALIYA SHAMSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

34 HUNTER LN
GLASTONBURY CT
06033-1422
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax:
Mailing address:
  • Phone: 860-338-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046852
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: