Healthcare Provider Details

I. General information

NPI: 1558773531
Provider Name (Legal Business Name): DR. SHRUTI KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4A DEVINE ST
NORTH HAVEN CT
06473-2142
US

IV. Provider business mailing address

4A DEVINE ST
NORTH HAVEN CT
06473-2142
US

V. Phone/Fax

Practice location:
  • Phone: 202-843-9010
  • Fax: 860-295-9734
Mailing address:
  • Phone: 203-843-9010
  • Fax: 860-295-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number61574
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: