Individual
SHAHANA LEE THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2416 WHITNEY AVE FL 1, HAMDEN, CT 06518-3248
(203) 407-3550
(203) 407-4244
Mailing address
2408 WHITNEY AVE, HAMDEN, CT 06518-3209
(203) 626-0160
(203) 294-6734
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3231
CT
Other
Enumeration date
11/04/2014
Last updated
10/09/2024
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