Provider Demographics
NPI:1538389978
Name:SHELSTA, HEATHER NICOLE (MD)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:SHELSTA
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 1:499 FARMINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1943
Mailing Address - Country:US
Mailing Address - Phone:860-678-0202
Mailing Address - Fax:
Practice Address - Street 1:499 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1943
Practice Address - Country:US
Practice Address - Phone:860-678-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186107207W00000X
CT048086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008008199Medicaid
0714730001Medicare NSC
CT1598711723Medicare NSC
CT1619920592Medicare NSC
CT008008199Medicaid
CT0714730002Medicare NSC