Basic Information
| Provider Information | |||||||||
| NPI: | 1437647401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAIK | ||||||||
| FirstName: | AYESHA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.B.B.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | UCONN INTERNAL MEDICINE RESIDENCY PROGRAM | ||||||||
| Address2: | 263 FARMINGTON AVENUE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060301235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792147 | ||||||||
| FaxNumber: | 8606794624 | ||||||||
| Practice Location | |||||||||
| Address1: | HARTFORD HOSPITAL | ||||||||
| Address2: | 79 RETREAT AVENUE | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609720200 | ||||||||
| FaxNumber: | 8605453149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/29/2018 | ||||||||
| NPIReactivationDate: | 12/14/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.