Healthcare Provider Details

I. General information

NPI: 1639735566
Provider Name (Legal Business Name): ZAKIR IQBALBHAI SHAIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date: 01/13/2020
Reactivation Date: 01/17/2020

III. Provider practice location address

80 S MAIN ST STE 101
MIDDLETOWN CT
06457-3648
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-5970
  • Fax:
Mailing address:
  • Phone: 860-358-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number76124
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: