Healthcare Provider Details

I. General information

NPI: 1922368810
Provider Name (Legal Business Name): MEGAN FRITTON SHUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN FRITTON GARDNER MD

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAYBROOK RD STE 210
MIDDLETOWN CT
06457-4759
US

IV. Provider business mailing address

495 HAWLEY LN STE 2A
STRATFORD CT
06614-1514
US

V. Phone/Fax

Practice location:
  • Phone: 860-740-2280
  • Fax:
Mailing address:
  • Phone: 203-210-6340
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD16473
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number56049
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: