1558387571 NPI number — SHYLA D. MURIEL M.D.

Table of content: SHYLA D. MURIEL M.D. (NPI 1558387571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558387571 NPI number — SHYLA D. MURIEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURIEL
Provider First Name:
SHYLA
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558387571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-1330
Provider Business Mailing Address Fax Number:
203-732-1332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 MAIN ST STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06478-1065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-888-5527
Provider Business Practice Location Address Fax Number:
203-888-3727
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  040015 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110234800 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5749774 . This is a "CIGNA HEALTHCARE OF CT" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CV5253 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2625841 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 010040015CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061394494 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2895920 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 040015 . This is a "CONNECTICARE, INC. & AFFI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001400150 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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