Healthcare Provider Details

I. General information

NPI: 1063269199
Provider Name (Legal Business Name): SHANA HARRIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2298
US

IV. Provider business mailing address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2298
US

V. Phone/Fax

Practice location:
  • Phone: 860-827-4751
  • Fax:
Mailing address:
  • Phone: 860-827-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5399
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: