Provider Demographics
NPI:1396397717
Name:MONTESERIN NARAYANA, SHOBA (CNM)
Entity type:Individual
Prefix:
First Name:SHOBA
Middle Name:
Last Name:MONTESERIN NARAYANA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHOBA
Other - Middle Name:
Other - Last Name:NARAYANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:111 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 PARK ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2520
Practice Address - Country:US
Practice Address - Phone:860-972-3179
Practice Address - Fax:860-972-2740
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT452176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife