Healthcare Provider Details

I. General information

NPI: 1770836827
Provider Name (Legal Business Name): NATALIE REBECCA SHILO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 07/21/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 500
HARTFORD CT
06106-5524
US

IV. Provider business mailing address

85 SEYMOUR ST STE 500
HARTFORD CT
06106-5524
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-7564
  • Fax:
Mailing address:
  • Phone: 860-837-7564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number56611
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA123060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: