Pediatric & Adolescent Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PEDIATRIC & ADOLESCENT MEDICINE

Practice address

580 Burnside Ave
Suite 3
East Hartford, CT 06108-3579

Phone

(860) 282-7128

Fax

(860) 646-1261

NPI assigned

Jun 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shaheen Ahmed

Title

Owner

Phone

(860) 643-5218

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1265472583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 BURNSIDE AVE",
            "address_2": "SUITE 3",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083579",
            "telephone_number": "860-282-7128",
            "fax_number": "860-646-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 BURNSIDE AVE",
            "address_2": "SUITE 3",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083579",
            "telephone_number": "860-282-7128",
            "fax_number": "860-646-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC & ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "SHAHEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-643-5218"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004247252",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parnian Pasandeh, DDS
• Suhanee Patel
• Path to Renewal Therapy Services LLC
• Glenroy Patrick Patterson, BCBA
• Alexander S. Peck Jr., M.D.
• Gisselt Peguero
• Emily Pelletier, LCSW
• Leury Pena
• Kathryn Terese Pennington, RN
• Christopher James Percy, M.A.

• Internal Medicine Physician in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.