MEDICARE: DR. ROUZI SHENGELIA M.D.

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	2084P0800X	Psychiatry Physician	291974	NY
2	2084P0800X	Psychiatry Physician	A168665	CA
3	2084P0800X	Psychiatry Physician	69410	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659781722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROUZI SHENGELIA M.D.

Provider Business Mailing Address
First Line	:	500 POST RD E
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4431
Country	:	US
Telephone Number	:	203-635-8770
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 POST RD E
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4431
Country	:	US
Telephone Number	:	203-635-8770
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	02/28/2025

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