Individual
SHANIQUE BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
428 COLUMBUS AVENUE, PODIATRY, NEW HAVEN, CT 06519-1233
(203) 503-3070
(203) 503-3107
Mailing address
27 HOSPITAL AVE STE 301, DANBURY, CT 06810-5954
(203) 826-9767
(203) 826-9858
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1056
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074725
CSR
CT
Enumeration date
06/25/2015
Last updated
10/03/2023
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