Provider Demographics
NPI:1861621005
Name:SHIN, GYEYEE (MD)
Entity type:Individual
Prefix:DR
First Name:GYEYEE
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4699 MAIN STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-374-2747
Mailing Address - Fax:203-372-0204
Practice Address - Street 1:4699 MAIN STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-374-2747
Practice Address - Fax:203-372-0204
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT047909OtherSTATE LICENSE
CT00804139Medicaid
1861621005OtherNPI
1861621005OtherNPI
FS1562392OtherDEA