Provider Demographics
NPI:1538235163
Name:SUBRAMANIAN, SHIELA V (MD)
Entity type:Individual
Prefix:
First Name:SHIELA
Middle Name:V
Last Name:SUBRAMANIAN
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 1:173 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW CAUAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-972-4255
Mailing Address - Fax:203-801-2126
Practice Address - Street 1:173 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:NEW CAUAAN
Practice Address - State:CT
Practice Address - Zip Code:06840
Practice Address - Country:US
Practice Address - Phone:203-972-4255
Practice Address - Fax:203-801-2126
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010039463CT01OtherANTHEM BLUE CROSS
2873549OtherAETNA
521725543OtherUNITED HEALTH CARE
P2639474OtherOXFORD
6160849003OtherCIGNA
521725543OtherUNITED HEALTH CARE
P2639474OtherOXFORD