Provider Demographics
NPI:1194565903
Name:AGRAWAL, SHRAIY
Entity type:Individual
Prefix:
First Name:SHRAIY
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 E MAIN ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2963
Mailing Address - Country:US
Mailing Address - Phone:347-406-2276
Mailing Address - Fax:
Practice Address - Street 1:200B VILLAGE WALK
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2745
Practice Address - Country:US
Practice Address - Phone:203-458-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009990152W00000X
390200000X
CT3350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program