| Waire Llc | |
| 
					105 West Rd Ellington CT 06029-5700  | |
| (860) 871-5402 | |
| (860) 871-5413 | 
| Full Name | Waire Llc | 
|---|---|
| Speciality | Psychiatry & Neurology | 
| Location | 105 West Rd, Ellington, Connecticut | 
| Authorized Official Name and Position | Erum Shahab (OWNER) | 
| Authorized Official Contact | 8608715402 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Waire Llc 105 West Rd Ellington CT 06029-4247 Ph: (860) 871-5402  | Waire Llc 105 West Rd Ellington CT 06029-5700 Ph: (860) 871-5402  | 
| NPI Number | 1871744243 | 
|---|---|
| Provider Enumeration Date | 10/03/2008 | 
| Last Update Date | 02/24/2015 | 
| Medicare PECOS PAC ID | 4183782360 | 
|---|---|
| Medicare Enrollment ID | O20081016000105 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1871744243 | NPI | - | NPPES | 
| Provider Name | Erum Shahab | 
|---|---|
| Provider Type | Practitioner - Psychiatry | 
| Provider Identifiers | NPI Number: 1669434049 PECOS PAC ID: 8527069194 Enrollment ID: I20070530000179  | 
| Provider Name | Kelly A Schmidt | 
|---|---|
| Provider Type | Practitioner - Clinical Psychologist | 
| Provider Identifiers | NPI Number: 1073828117 PECOS PAC ID: 2365637014 Enrollment ID: I20101108001444  | 
| Provider Name | Serita Smith | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1417203142 PECOS PAC ID: 2062661085 Enrollment ID: I20121009000005  | 
| Provider Name | Charles V Lange | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1790020840 PECOS PAC ID: 3870870405 Enrollment ID: I20170508001369  | 
| Provider Name | Cassandra Shepard | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1740718618 PECOS PAC ID: 9436422508 Enrollment ID: I20170912001926  | 
| Provider Name | William Abrokwa | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1205346335 PECOS PAC ID: 0749547651 Enrollment ID: I20171201000693  | 
| Provider Name | Radmila M Meyer | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1174090617 PECOS PAC ID: 3274872569 Enrollment ID: I20190304002701  | 
| Provider Name | Christian Edward Klein | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1730490061 PECOS PAC ID: 5597186585 Enrollment ID: I20200529000981  | 
| Provider Name | Mojdeh Heidari | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1306300397 PECOS PAC ID: 7719363514 Enrollment ID: I20221003000236  |