Healthcare Provider Details

I. General information

NPI: 1780574475
Provider Name (Legal Business Name): SHAH WOUND SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 STATE ST APT 2721
NEW HAVEN CT
06510-3628
US

IV. Provider business mailing address

360 STATE ST APT 2721
NEW HAVEN CT
06510-3628
US

V. Phone/Fax

Practice location:
  • Phone: 312-342-1901
  • Fax:
Mailing address:
  • Phone: 312-342-1901
  • Fax: 855-538-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ABHINIT DRUPAD SHAH
Title or Position: OWNER/MEDICAL DIRECTOR/AO
Credential: MD
Phone: 312-342-1901