Provider Demographics
NPI:1528112299
Name:ISAAC, SHIJI A (MD)
Entity type:Individual
Prefix:
First Name:SHIJI
Middle Name:A
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PARK PALCE CIRCLE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110
Mailing Address - Country:US
Mailing Address - Phone:917-797-9869
Mailing Address - Fax:
Practice Address - Street 1:505 WILLARD AVENUE
Practice Address - Street 2:BUILDING 2, SUITE C
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-666-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics