MEDICARE: SHAZIA JOSEPHINE JOSEPH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12.008172	CT

General Provider Information

NPI Number	:	1336703586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAZIA JOSEPHINE JOSEPH APRN

Provider Business Mailing Address
First Line	:	12 VILLAGE ST STE 5
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3828
Country	:	US
Telephone Number	:	203-843-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 VILLAGE ST STE 5
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3828
Country	:	US
Telephone Number	:	203-843-4629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/24/2026

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