Healthcare Provider Details

I. General information

NPI: 1922597830
Provider Name (Legal Business Name): SHELTON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRAP FALLS RD STE 101
SHELTON CT
06484-4616
US

IV. Provider business mailing address

220 FANS ROCK RD
HAMDEN CT
06518-2017
US

V. Phone/Fax

Practice location:
  • Phone: 203-828-7185
  • Fax:
Mailing address:
  • Phone: 203-813-6175
  • Fax: 475-655-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number043900
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043900
License Number StateCT

VIII. Authorized Official

Name: DR. FADI HAMMOUD
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 203-437-0346