Provider Demographics
NPI:1588781850
Name:KASHANI, SHABNAM M (MD)
Entity type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:M
Last Name:KASHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4637 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5048
Mailing Address - Country:US
Mailing Address - Phone:203-374-8000
Mailing Address - Fax:203-374-2233
Practice Address - Street 1:4637 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5048
Practice Address - Country:US
Practice Address - Phone:203-374-8000
Practice Address - Fax:203-374-2233
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045088207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT045088OtherMEDICAL LICENSE