Provider Demographics
NPI:1124690789
Name:DUGGAL, SHVETA
Entity type:Individual
Prefix:
First Name:SHVETA
Middle Name:
Last Name:DUGGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20621 COMO LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4188
Mailing Address - Country:US
Mailing Address - Phone:818-736-7652
Mailing Address - Fax:
Practice Address - Street 1:300 UCONN HEALTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2985
Practice Address - Country:US
Practice Address - Phone:860-679-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13837390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program