Healthcare Provider Details

I. General information

NPI: 1932172830
Provider Name (Legal Business Name): SHIVEN B CHABRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST SIXTH FLOOR
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE #201
MIDDLEBURY CT
06762-1805
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6263
  • Fax: 203-573-6030
Mailing address:
  • Phone: 203-573-9512
  • Fax: 203-568-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042658
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number042658
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042658
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: