Healthcare Provider Details

I. General information

NPI: 1699695411
Provider Name (Legal Business Name): WARDA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 BOSTON POST RD
MILFORD CT
06460-3536
US

IV. Provider business mailing address

831 BOSTON POST RD
MILFORD CT
06460-3536
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-5860
  • Fax:
Mailing address:
  • Phone: 203-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15773
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: