Healthcare Provider Details

I. General information

NPI: 1710316385
Provider Name (Legal Business Name): RIDDHI SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WEST ST,
SOUTHINGTON CT
06489
US

IV. Provider business mailing address

1115 WEST ST
SOUTHINGTON CT
06489
US

V. Phone/Fax

Practice location:
  • Phone: 860-276-6090
  • Fax: 860-276-6059
Mailing address:
  • Phone: 860-276-6090
  • Fax: 860-276-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number055332
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: