Provider Demographics
NPI: | 1285082891 |
---|---|
Name: | SHUJAAT, SYEDA DANIA |
Entity type: | Individual |
Prefix: | |
First Name: | SYEDA DANIA |
Middle Name: | |
Last Name: | SHUJAAT |
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: | 85 SEYMOUR STREET |
Mailing Address - Street 2: | HARTFORD HOSPITAL NEUROLOGY DEPT |
Mailing Address - City: | HARTFORD |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06106-5527 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 860-972-3621 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 85 SEYMOUR STREET |
Practice Address - Street 2: | HARTFORD HOSPITAL NEUROLOGY DEPT |
Practice Address - City: | HARTFORD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06106-5527 |
Practice Address - Country: | US |
Practice Address - Phone: | 860-972-3621 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-05-25 |
Last Update Date: | 2022-06-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 180046503 | 207R00000X |
CT | 069500 | 2084A2900X, 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 2084A2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurocritical Care |