1922368810 NPI number — DR. MEGAN FRITTON SHUE MD

Table of content: DR. MEGAN FRITTON SHUE MD (NPI 1922368810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922368810 NPI number — DR. MEGAN FRITTON SHUE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUE
Provider First Name:
MEGAN
Provider Middle Name:
FRITTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDNER
Provider Other First Name:
MEGAN
Provider Other Middle Name:
FRITTON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922368810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 HAWLEY LN STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06614-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-210-6340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 SAYBROOK RD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-740-2280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2012

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: MD16473 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 56049 , 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)