=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578676862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE SHAFTS DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 06/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 REYNOLDS ST
-----------------------------------------------------
City | DANIELSON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06239-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-774-7501
-----------------------------------------------------
Fax | 860-779-2191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 MANSFIELD AVE
-----------------------------------------------------
City | WILLIMANTIC
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06226-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-450-7471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 045704
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------