Provider Demographics
NPI:1659781722
Name:SHENGELIA, ROUZI (MD)
Entity type:Individual
Prefix:DR
First Name:ROUZI
Middle Name:
Last Name:SHENGELIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4431
Mailing Address - Country:US
Mailing Address - Phone:203-635-8770
Mailing Address - Fax:
Practice Address - Street 1:500 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4431
Practice Address - Country:US
Practice Address - Phone:203-635-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2919742084P0800X
CAA1686652084P0800X
CT694102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1659781722Medicaid