Provider Demographics
NPI:1639116957
Name:COMSHAW, RICHARD FRANK II (PHD APRN)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANK
Last Name:COMSHAW
Suffix:II
Gender:M
Credentials:PHD APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 CONGDON ST E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2063
Mailing Address - Country:US
Mailing Address - Phone:860-736-4139
Mailing Address - Fax:
Practice Address - Street 1:2275 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2329
Practice Address - Country:US
Practice Address - Phone:860-996-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE55764163WP0808X
CT001702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0-001702Medicare UPIN
CT500000340Medicare ID - Type Unspecified