Provider Demographics
NPI:1538267356
Name:GHOFRANY, SHIEVA L (MD)
Entity type:Individual
Prefix:
First Name:SHIEVA
Middle Name:L
Last Name:GHOFRANY
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 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-353-9099
Mailing Address - Fax:203-353-9699
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE A2
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-353-9099
Practice Address - Fax:203-353-9699
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041579174400000X
CT014579207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT041579OtherLICENSE
CT041579OtherLICENSE