Healthcare Provider Details

I. General information

NPI: 1073519658
Provider Name (Legal Business Name): SHAHNAZ HUSSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CEDAR ST
NEWINGTON CT
06111-2647
US

IV. Provider business mailing address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-1244
  • Fax: 860-666-5153
Mailing address:
  • Phone: 860-667-1244
  • Fax: 860-666-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number024449
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: