Individual
SHELLEY BURCHSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
90 S MAIN ST, FAMILY RESIDENCY PROGRAM, MIDDLETOWN, CT 06457-3649
(860) 358-6300
(860) 358-9249
Mailing address
90 S MAIN ST, FAMILY RESIDENCY PROGRAM, MIDDLETOWN, CT 06457-3649
(860) 358-6300
(860) 358-9249
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56065
CT
208M00000X
Hospitalist Physician
56065
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56065
ST LIC
CT
Enumeration date
07/05/2013
Last updated
08/11/2017
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