Healthcare Provider Details

I. General information

NPI: 1437647401
Provider Name (Legal Business Name): AYESHA A SHAIK M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 11/29/2018
Reactivation Date: 12/14/2018

III. Provider practice location address

19 OLD ROLLINSFORD RD BLDG B
DOVER NH
03820-2807
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-1235
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-4265
  • Fax:
Mailing address:
  • Phone: 860-679-2147
  • Fax: 860-679-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38894
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: