Healthcare Provider Details

I. General information

NPI: 1497731509
Provider Name (Legal Business Name): WILLIAM S SHIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 SULLIVAN AVE HARTFORD MEDICAL GROUP
SOUTH WINDSOR CT
06074-2712
US

IV. Provider business mailing address

1559 SULLIVAN AVE HARTFORD MEDICAL GROUP
SOUTH WINDSOR CT
06074-2712
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2350
  • Fax: 860-696-2360
Mailing address:
  • Phone: 860-696-2350
  • Fax: 860-696-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035837
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: