Healthcare Provider Details

I. General information

NPI: 1689254567
Provider Name (Legal Business Name): PAYAL SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LN
TRUMBULL CT
06611-5300
US

IV. Provider business mailing address

160 HAWLEY LN
TRUMBULL CT
06611-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-0639
  • Fax: 203-386-9706
Mailing address:
  • Phone: 203-377-0639
  • Fax: 203-386-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number85337
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: