| Shanthi Devaraj, M.D., LLC | |
|
1400 Bedford St Stamford CT 06905-5200 | |
| (203) 323-8700 | |
| (203) 323-1785 |
| Full Name | Shanthi Devaraj, M.D., LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 Bedford St, Stamford, Connecticut |
| Authorized Official Name and Position | Shanthi Devaraj (MEMBER) |
| Authorized Official Contact | 2033238700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shanthi Devaraj, M.D., LLC 1400 Bedford St Stamford CT 06905-5200 Ph: (203) 323-8700 | Shanthi Devaraj, M.D., LLC 1400 Bedford St Stamford CT 06905-5200 Ph: (203) 323-8700 |
| NPI Number | 1871803650 |
|---|---|
| Provider Enumeration Date | 10/14/2010 |
| Last Update Date | 10/14/2010 |
| Medicare PECOS PAC ID | 9234322132 |
|---|---|
| Medicare Enrollment ID | O20101025000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871803650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036375 (Connecticut) | Primary |
| Provider Name | Shanthi Devaraj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063565844 PECOS PAC ID: 0143413047 Enrollment ID: I20101025000133 |
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