Provider Demographics
NPI:1336150036
Name:SHAKIBAI, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SHAKIBAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 MAIN STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-649-8074
Mailing Address - Fax:860-647-1129
Practice Address - Street 1:953 MAIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-649-8074
Practice Address - Fax:860-647-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84273Medicare UPIN