Healthcare Provider Details

I. General information

NPI: 1629381132
Provider Name (Legal Business Name): ANNIE SHAJI DANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
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: 860-612-6305
  • Fax: 860-612-6304
Mailing address:
  • Phone: 860-612-6305
  • Fax: 860-612-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number054504
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number054504
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: