Healthcare Provider Details

I. General information

NPI: 1447273511
Provider Name (Legal Business Name): SHUTISH CHANDRA PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WEST MAIN STREET HARTFORD ORTHOPEDIC MEDICINE, PC-FIRST FLOOR
NEW BRITAIN CT
06052-1315
US

IV. Provider business mailing address

136 WEST MAIN STREET HARTFORD ORTHOPEDIC MEDICINE, PC-FIRST FLOOR
NEW BRITAIN CT
06052-1315
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-4763
  • Fax: 860-826-4765
Mailing address:
  • Phone: 860-826-4763
  • Fax: 860-826-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number025967
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: