Provider Demographics
NPI:1144881574
Name:SHAJAHAN MOIDU, ZAINAB SANAA (MD)
Entity type:Individual
Prefix:DR
First Name:ZAINAB SANAA
Middle Name:
Last Name:SHAJAHAN MOIDU
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 1:95 HOCKANUM BLVD UNIT 4003
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-7000
Mailing Address - Country:US
Mailing Address - Phone:216-804-4082
Mailing Address - Fax:
Practice Address - Street 1:1331 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4346
Practice Address - Country:US
Practice Address - Phone:860-529-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT71947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program