Healthcare Provider Details

I. General information

NPI: 1427004563
Provider Name (Legal Business Name): HEART SPECIALISTS PC OF SOUTHERN CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CORPORATE DR SUITE 100
SHELTON CT
06484-6211
US

IV. Provider business mailing address

4 CORPORATE DR SUITE 100
SHELTON CT
06484-6211
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-9799
  • Fax: 203-925-8264
Mailing address:
  • Phone: 203-929-9799
  • Fax: 203-925-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY DSOUZA
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-929-9799