Healthcare Provider Details

I. General information

NPI: 1366497299
Provider Name (Legal Business Name): MERIDEN HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 BROAD ST
MERIDEN CT
06450-4364
US

IV. Provider business mailing address

834 BROAD ST
MERIDEN CT
06450-4364
US

V. Phone/Fax

Practice location:
  • Phone: 203-238-3788
  • Fax: 203-238-3790
Mailing address:
  • Phone: 203-238-3788
  • Fax: 203-238-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033368
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4217
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042588
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046516
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031248
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033904
License Number StateCT

VIII. Authorized Official

Name: SHAHEEN AHMED
Title or Position: OWNER
Credential:
Phone: 203-238-3788