Basic Information
| Provider Information | |||||||||
| NPI: | 1356500532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOOD | ||||||||
| FirstName: | SHIVANI | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 WAWECUS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
| FaxNumber: | 8608879003 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 WAWECUS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
| FaxNumber: | 8608879003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 046556 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | P00687675 | 01 | MEDICARE RAILROAD PTAN | OTHER | 010046556CT01 | 01 | CT | ANTHEM BLUE CROSS BLUE SHIELD OF CT | OTHER | 046556 | 01 | CT | CONNECTICARE, INC | OTHER | 9643135 | 01 | AETNA | OTHER | P3929070 | 01 | OXFORD | OTHER |