Healthcare Provider Details

I. General information

NPI: 1346685252
Provider Name (Legal Business Name): SHOSHANA STREITER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

375 BOYLSTON ST
BROOKLINE MA
02445-6007
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6162
  • Fax: 203-573-7354
Mailing address:
  • Phone: 857-307-0896
  • Fax: 857-307-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number276696
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number276696
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: