Individual
J KEVIN SHUSHTARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
326 WASHINGTON ST, NORWICH, CT 06360-2740
(941) 917-4896
(941) 917-6884
Mailing address
PO BOX 863407, ORLANDO, FL 32886-3407
(941) 917-4896
(941) 917-6884
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036002
CT
207R00000X
Internal Medicine Physician
ME121844
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001360023
—
CT
01
—
010036002CT01
BLUE CROSS
CT
01
—
110247602
RAILROAD MEDICARE
—
01
—
1221925
UNITED
—
01
—
2V2738
HEALTHNET
—
01
—
3114253
AETNA
—
01
—
P2832183
OXFORD
—
Enumeration date
02/23/2006
Last updated
10/13/2017
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