Individual
DIANA SHAPOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
56 FRANKLIN ST, WATERBURY, CT 06706-1253
(203) 709-6000
Mailing address
30 SEMINARY ST, BRISTOL, CT 06010-5520
(908) 229-7685
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/18/2020
Last updated
04/18/2020
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