Organization
SURGICAL SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYAKARA SHETTY MD (PRESIDENT)
(203) 755-6666
Entity
Organization
Contact information
Practice address
134 GRANDVIEW AVE, SUITE 209, WATERBURY, CT 06708-2507
(203) 755-6666
(203) 573-6735
Mailing address
134 GRANDVIEW AVE, SUITE 209, WATERBURY, CT 06708-2507
(203) 755-6666
(203) 573-6735
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
024773
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001247733
—
CT
01
—
010024773CT02
ANTHEM BCBS
CT
01
—
0199318
GHI
CT
01
—
020045404
RAILROAD MEDICARE
CT
01
—
024773
CONNECTICARE
CT
01
—
0R0463
HEALTHNET
CT
01
—
130555
WELLCARE
CT
01
—
556517
AETNA USH
CT
01
—
NHS039
OXFORD HEALTHPLAN
CT
Enumeration date
03/28/2007
Last updated
11/03/2009
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