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General NPI Number Information
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NPI Number | 1609394576
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Entity Type | Individual
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Provider Name | MANSI NAYANKUMAR SHAH
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 670 MAIN ST
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City | TORRINGTON
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State | CT
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Zip | 06790-3603
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Country | US
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Telephone | 860-618-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 7 ACADIA LN PH 5409
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City | SHELTON
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State | CT
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Zip | 06484-4465
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Country | US
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Telephone | 469-400-3163
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11879
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License Number State | CT
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