Healthcare Provider Details

I. General information

NPI: 1336703586
Provider Name (Legal Business Name): SHAZIA JOSEPHINE JOSEPH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 DERBY AVE
WEST HAVEN CT
06516-1008
US

IV. Provider business mailing address

1427 CHAPEL ST
NEW HAVEN CT
06511-4403
US

V. Phone/Fax

Practice location:
  • Phone: 209-997-0155
  • Fax: 203-997-0462
Mailing address:
  • Phone: 203-865-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8172
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: