Provider Demographics
NPI:1861600165
Name:SHIA, DEREK S (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:S
Last Name:SHIA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-626-0160
Practice Address - Street 1:9 WASHINGTON AVE FL 1A
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3267
Practice Address - Country:US
Practice Address - Phone:203-865-6784
Practice Address - Fax:203-865-6788
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-04-27
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Provider Licenses
StateLicense IDTaxonomies
CT50534207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1861600165Medicaid
CTD400168443Medicare Oscar/Certification