Healthcare Provider Details

I. General information

NPI: 1750075925
Provider Name (Legal Business Name): SHIMONA MALIK LEE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S BROAD ST STE 3B
MERIDEN CT
06450-6601
US

IV. Provider business mailing address

370 WEST AVE APT 317
NORWALK CT
06850-5002
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-7449
  • Fax:
Mailing address:
  • Phone: 240-997-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14790
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1859919
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: