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General NPI Number Information
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NPI Number | 1356382105
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Entity Type | Individual
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Provider Name | DANA SHAKED M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 310 MAIN ST
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City | WESTPORT
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State | CT
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Zip | 06880-2413
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Country | US
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Telephone | 202-227-5437
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | WESTPORT
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State | CT
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Zip | 06881-0306
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Country | US
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Telephone | 203-434-2232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 043620
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License Number State | CT
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