Organization
PEDIATRIC & ADOLESCENT MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHEEN AHMED (OWNER)
(860) 643-5218
Entity
Organization
Contact information
Practice address
580 BURNSIDE AVE, SUITE 3, EAST HARTFORD, CT 06108-3579
(860) 282-7128
(860) 646-1261
Mailing address
580 BURNSIDE AVE, SUITE 3, EAST HARTFORD, CT 06108-3579
(860) 282-7128
(860) 646-1261
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004247252
—
CT
Enumeration date
06/07/2006
Last updated
12/16/2014
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